Exercise therapy for diseases of the digestive system. Chapter v. physical therapy for diseases of the digestive system Complex exercise therapy for diseases of the digestive system

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Ministry of Education of the Russian Federation

Khabarovsk State Pedagogical University

Essay

" Therapeutic exercise for diseases digestive organs "

Completed by: 1st year student 213 gr.

Lagoiko Evgeniy VladAndMirovich

Checked by the teacher:

Ushakov Stepan VladimAndRovich

Khabarovsk 2002

“Movement can replace any remedy in its action, but all the healing agents in the world cannot replace the action of movement” ( T isso ).

Therapeutic exercise is integral part general physical education and one of the most important methods of complex treatment of patients with peptic ulcer, as well as effective means preventing exacerbations with the correct structure of classes and the entire complex.

The purpose of this work is to indicate the physiological basis for the use of exercise therapy for this disease, some guidelines, as well as an approximate structure of classes and basic exercises.

Let's start with physiology. Impulses from the receptors of internal organs enter the central nervous system, signaling the intensity of functioning and the condition of the organs. When the disease occurs, reflex regulation is disrupted, pathological dominants and vicious (pathological) reflexes arise, distorting the course of normal processes in the human body.

The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and functioning of any living organism. Therefore, exercise therapy is a very important element in the treatment of ulcerative processes.

It is already known that performing dosed physical exercises, accompanied by positive changes in the functional state of the centers of the subcutaneous region and an increase in the level of basic life processes, causes positive emotions (the so-called psychogenic and conditioned reflex influence). This is especially applicable in case of peptic ulcer disease, when the neuropsychic state of patients leaves much to be desired (normalization of the symptoms of dystonia expressed in patients nervous system. It should be noted the impact of physical activity on the nervous regulation of the digestive system.

With regular exercise, as in the process of physical training, energy reserves gradually increase, the formation of buffer compounds increases, and the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This leads to the activation of redox processes and to an increase in the stability of acid-base balance, which in turn has a beneficial effect on the scarring of the ulcerative defect (impact on the trophic and regenerative potency of the gastrointestinal tract tissues).

The effect of physical exercise is determined by its intensity and time of use. Small and moderate muscle tensions stimulate the basic functions of the gastrointestinal tract, while intense ones depress them.

There is a beneficial effect of exercise therapy on blood circulation and breathing, which also expands the functional capabilities of the body and increases its reactivity.

Depending on the clinical nature of the disease and the functionality of the patient, various forms and means are used. Since usually in educational institutions they use, if possible, only the third (general developmental) health complex exercise, then I will stick to it too.

Contraindications to classes include:

Fresh ulcer in the acute period.

Ulcer complicated by bleeding.

Preperforative state.

An ulcer complicated by stenosis in the stage of decompensation.

Fresh massive paraprocesses during penetration.

Exercise therapy when applied to patients suffering from peptic ulcer health benefits carried out in the following directions:

physiotherapy digestive disease

Influence the regulation of excitation and inhibition processes in the cerebral cortex; to strengthen cortico-visceral innervation and equalize related disorders of autonomic innervation. Improve the coordinated functioning of the circulatory, respiratory and digestive systems.

By properly organizing the regime of movements, physical exercise and passive rest, influence the regulation of the patient’s neuropsychic sphere.

Improve redox processes in all organs, promote the normal course of trophic processes.

Counteract dysfunctions of the digestive system that occur with peptic ulcers (constipation, loss of appetite, congestion, etc.).

The principle of individualization when applying physical therapy for this disease is mandatory.

General tonic training regimen

Prescribed after the disappearance of pain and exacerbation in the absence of complaints about the main signs of the disease with a general improvement in condition. Appointment dates are in 20-26 days.

Goal: Restoring the patient’s adaptation to the loads of the extended regime. Increasing stimulation metabolic processes, impact on the regulation of excitation and inhibition processes in the cerebral cortex, impact on the normalization of autonomic functions. Fighting congestion in abdominal cavity. Promoting regenerative processes in the gastrointestinal tract.

Contents of the regime - With relative sparing of the abdominal area, strength and endurance training is carried out. The range of motion in large joints gradually expands and breathing deepens to the maximum possible in each case. To combat dyskinesia of the large intestine, changing starting positions becomes more frequent. Sudden movements are excluded.

Characteristics of the used physical exercises. From the initial positions lying down, on the side, etc., the movements are gradually expanded to full amplitude for large joints at a slow and medium pace. Includes exercises for all muscles abdominals executing in at a slow pace with limited amplitude and exclusion of sudden movements.

The intensity of performing resistance exercises for the muscles of the shoulder girdle and intercostal muscles for the purpose of a reflex effect on the digestive organs in segments D 6-9. You can use dumbbells weighing up to 2-4 kg, medicine balls weighing no more than 2-3 kg, exercises on sports equipment. To combat congestion good effect given with diaphragmatic breathing from various starting positions, which is brought to great depth, alternating with chest and full breathing; Changing it more frequently also helps. etc., exercises, games and loads when they become more complex. Gradually, increasingly complex attention exercises are included in the classes. The density of classes remains no higher than average.

Walking is increased to 4-5 km per day. With general good health and absence of pain, ball games (volleyball, etc.) are allowed, taking into account individual reactions, lasting no more than 25-35 minutes. Including various types of games in the course helps maintain interest and increases the production of positive emotions during general physical activity.

Throughout the course, students should be pointed out to the positive changes achieved in their condition and physical development, to suggest that stomach disorders are minor and easily correctable (psychological impact).

Exercise therapy is effective only if long-term, systematic classes are carried out with a gradual increase in load both in each of them and throughout the course. Both the coach and the student must know this in order to achieve appropriate results.

Below is a table of approximate structure of a lesson for the remission stage of the ulcerative process. Of course, it cannot be accepted as a standard - each trainer and methodologist makes his own amendments and additions and creates his own specific tactics and exercise methods, unlike all other courses.

Strict consistency in increasing the load and its individualization are the main conditions for conducting all classes. In this case, the condition, reaction of those involved, features of the clinical course, concomitant diseases and physical should be taken into account. students' preparedness.

Another thing is also important: by doing physical exercises, the patient himself actively participates in the healing process, and

this has a beneficial effect on his psycho-emotional sphere.

Classes also have an educational value: students get used to systematically performing physical exercises, this becomes their daily habit. Exercise therapy classes turn into general physical education classes and become a human need even after recovery.

Physical therapy for gastritis

It is advisable to also include physical therapy in anti-relapse treatment. Physical education has a tonic effect on the entire body, improves metabolism, normalizes nervous reactions, changes intra-abdominal pressure, and improves blood circulation in the abdominal cavity.

Therapeutic exercise for patients with chronic gastritis occurring with secretory insufficiency should be moderate and aimed at strengthening the abdominal muscles, general strengthening. Walking, as well as dosed walking, are recommended.

In patients with increased secretion, the load during exercise should be significantly greater - at the level of submaximal work power, but the number of exercises for the abdominal muscles should be limited and they should be performed with a moderate load. When combining dietary nutrition, drinking mineral water and physical therapy, it is most advisable for chronic gastritis with increased secretion of the digestive glands to drink mineral water before physical exercise, and eat food 15-20 minutes after exercise.

For gastritis with reduced secretion, you should drink mineral water after physical education classes 15-20 minutes before meals.

Maintaining a proper diet, combating smoking and alcohol abuse, identifying and treating other diseases of the digestive system, sanitation of the oral cavity - all these measures will prevent the occurrence and progression of chronic gastritis.

Running helps normalize the acidity of gastric juice. So, if the secretion of gastric juice is reduced, drink a glass of magnetized water before running - this will enhance the secretory function of the stomach. Run for at least 30 minutes and no more than an hour.

When secretion is increased or normal, you can drink a glass of oatmeal or rolled oats before running to neutralize the increased acidity.

Approximate scheme during the period of remission

Walking is simple and complicated (combines movements of the arms and legs). Rhythmically, at a calm pace.		Gradual involvement in the load, development of coordination of movements.
Exercises for arms and legs combined with body movements and breathing exercises in sitting positions.		The same, a gradual increase in intra-abdominal pressure. Increased blood circulation in the abdominal cavity.
Standing. Exercises in throwing and catching balls, relay races. Alternating with breathing exercises.		General physiological load. Creating conditions for the development of positive emotions. Development of full breathing functions.
Exercises to develop balance in alternation with exercises on a gymnastic wall such as mixed hangs.		General tonic effect on the nervous system, development of static-dynamic stability.
Lying down. Basic exercises for the limbs combined with deep breathing.		Load reduction. Development of full breathing.
	TOTAL 37-61

Literature

1. Gishberg L.S. Clinical indications for the use of physical therapy for diseases of internal organs., SMOLGIZ, 1948

2. Moshkov V.N. Physical therapy in the clinic of internal diseases., M., 1952

3. METHODOLOGICAL LETTER: Therapeutic physical education during inpatient treatment., M., 1962

4. Yakovleva L.A. Therapeutic exercise for chronic diseases of the abdominal organs., Kyiv 1968

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Muscular work influences various functions of the digestive system according to the principle of motor-visceral reflexes. The changes that occur as a result of physical activity are different. Intense muscular work sharply inhibits motor, secretory and absorption functions, and moderate loads stimulate the activity of the digestive system.

In turn, physical activity, through afferent, proprioceptive impulses from working muscles, influences the central mechanisms of regulation of digestion in the brain. Special physical exercises for the abdominal muscles have a direct effect on intra-abdominal pressure; diaphragmatic breathing exercises change the position of the diaphragm, putting pressure on the liver and gall bladder. The combination of all these factors determines the positive role of the use of exercise therapy in the complex treatment of patients with diseases of the digestive system.

The task of exercise therapy: to promote the strengthening and healing of the body; influence the neurohumoral regulation of digestion; stimulate blood circulation in the abdominal cavity and pelvis; strengthen the abdominal muscles; contribute to the normalization of secretory, motor and absorption functions; prevent congestion in the abdominal cavity, promote the development of full breathing function, the ability to use the advantages of diaphragmatic breathing in this pathology; provide positive impact on the psycho-emotional sphere.

Exercise therapy for chronic gastritis

Chronic gastritis is a polyetiological, very common disease that affects the gastric mucosa. In the acute phase and during exacerbations, pain, nausea, and vomiting are expressed. After these phenomena subside, you can prescribe therapeutic exercises, but exclude abdominal exercises. Use general strengthening exercises for the arms and legs in combination with breathing. In the chronic stage without exacerbation, the features of exercise therapy depend on the nature of secretion.

With reduced secretion, the load should be moderate. Apply general strengthening and special exercises for the abdominal muscles and abdominal breathing in IP while standing, sitting, lying down; complicated walking is prescribed. The duration of the procedures is 20-30 minutes.

The therapeutic exercise procedure is carried out before taking mineral water. In patients with normal and increased secretion, the overall physical activity should be greater and even submaximal, but abdominal exercises should be limited and reduced. Therapeutic exercise is carried out after drinking mineral water, before eating. The sanatoriums recommend walking, health paths, swimming, rowing, skating, skiing, moving and sport games. Abdominal massage is indicated, all techniques are used; In case of spastic intestinal condition, kneading techniques are excluded.

Exercise therapy for gastric and duodenal ulcers

Exercise therapy is prescribed only in the subacute and chronic stages, when there is no severe pain, constant nausea, vomiting, or bleeding. Therapeutic exercises are indicated after acute pain subsides 2-5 days after it stops. During this period, in a lying position, apply simple exercises for arms and legs in alternation with static and dynamic breathing. If there is a niche and hidden blood in the stool, therapeutic exercises can be prescribed, but exercises for the abdominal press and those that increase intra-abdominal pressure should not be used. As the pain disappears completely, the load is gradually and carefully increased. IP - lying down, sitting and then standing, procedure duration - 15-20 minutes. In sanatoriums, during the chronic course of the disease, exercises with a higher load are used, special for the abdominal press, mixed hangings and walking - simple and complex. The duration of the procedure is up to 30 minutes. Volleyball, rowing, skiing, and swimming are also shown.

Exercise therapy for biliary dyskinesia

Depending on the functional impairment of gallbladder contractility, dyskinesia is divided into hyperkinetic (hypertonic, spastic) and hypokinetic (hypotonic, spastic) atonic form). Taking into account the clinical forms of dyskinesia, the methods of therapeutic exercises are differentiated. In addition to the above tasks of physical therapy for diseases of the digestive organs, in patients with a hypokinetic form of dyskinesia, conditions should be created to facilitate the outflow of bile from the gallbladder.

Therapeutic gymnastics is indicated for both forms of dyskinesia, both during remission and with minimal subjective manifestations of the disease; with moderate pain syndrome physiotherapy can be used against the background of complex treatment. In case of exacerbation of the disease, therapeutic exercises are not used. During remission, physical activity increases, the motor mode can be training. Along with general developmental ones, special and breathing exercises, and the latter are among the special ones for this pathology. Special exercises that help strengthen the abdominal muscles are necessary for any form of dyskinesia. This ensures the prevention of relapses of the disease and accelerates the recovery of performance after a period of forced hypokinesia during an exacerbation of the disease. The basis of the exercise therapy technique for both forms of dyskinesia is the principle of constantly increasing physical activity while maintaining regularity of procedures.

In the hypokinetic form of dyskinesia, the total physical load is average, the physiological load curve has a two-peak character. IP - various: lying on your back, on your side, standing, sitting, on all fours, on your knees and others; in the remission stage, sitting and standing positions predominate. IP - lying on the left side is prescribed to improve the outflow of bile. For better emptying of the gallbladder and activation of intestinal function, various exercises(with gradually increasing load) for the abdominal muscles (including in IP - lying on your stomach) and breathing exercises. The latter, especially in combination with slower respiratory movements during inhalation and exhalation, help reduce and even relieve pain and dyspeptic symptoms (nausea, belching, etc.). Tilts of the torso forward and bends in combination with rotation of the torso, recommended to increase intra-abdominal pressure and improve the outflow of bile, are used with caution, since nausea and belching are often observed with these movements. Exercises should be lifted with full amplitude. Includes various types of walking, including with high lifting hips It is necessary to teach the patient how to relax muscles. Only the right combination of elements of effort and relaxation will ensure the success of the procedure. The pace is average, a transition to fast is possible, especially when performing exercises from easier starting positions. Sedentary games can be prescribed from the first procedures, active games - in the remission stage. The duration of the procedures is 20-30 minutes. Before carrying out classes, patients need passive rest for several minutes. The first 8-10 procedures of therapeutic exercises are carried out every other day, then daily (can be 2 times a day).

With the hyperkinetic form of dyskinesia, in the first classes they give a small amount of physical activity, followed by increasing it to medium. The physiological load curve should also have a two-peak character, but with a less sharp steepness of ascents and descents than with the hypokinetic form. A variety of IPs are used: the supine position predominates - it is most effective for muscle relaxation; in this position, subjective feelings of nausea are also reduced. Avoid pronounced static stress, especially for the abdominal muscles. Exercises for the abdominal muscles should be alternated with relaxation. Static and dynamic breathing exercises are shown, breathing exercises on the right side to improve blood supply to the liver, swing movements initially with limited and then full amplitude, exercises with apparatus and against a gymnastic wall. New equipment and exercises should be introduced into classes gradually. Exercises that normalize intestinal function are necessary. A variety of general strengthening exercises help improve the functioning of the heart muscle and the outflow of blood from the liver. The tempo is slow and transitions to medium. You can include elements of sedentary games. Competitive moments in games are not recommended for patients with the hydrokinetic form of dyskinesia using the group method of training. The duration of the procedures is 20-30 minutes. Before the session, passive rest is required for 3-7 minutes in a lying position, regardless of whether the procedure is carried out before or after the patient’s working day. While resting, the patient should perform self-massage of the abdomen, without involving the area of the liver, if there is even slight pain in the right quadrant. The first 10-12 procedures are carried out every other day, then daily. After training patients with an instructor, they can be recommended to do independent exercises at home.

Etiology and pathogenesis diseases of the digestive system are very diverse, leading value have disturbances in the activity of the nervous system, local effects on the gastrointestinal tract of possible exogenous factors and circulatory disorders in the abdominal area.

Disturbances in the activity of individual parts of the gastrointestinal tract are usually functional and reversible at first. As the disease progresses, functional disorders are accompanied by morphological changes, which subsequently become irreversible. Morphological changes, in turn, become a source of pathological impulses into the central nervous system and disrupt its corrective effect on the digestive organs and other organs and systems. As a result, organic damage to any part of the gastrointestinal tract is often combined with functional disorders of its other parts, as well as with a disorder in the activity of other systems.

Treatment of diseases of the digestive system is both etiological and pathogenetic, and exercise therapy occupies a significant place in this complex therapy.

Therapeutic effect physical exercise is primarily due to its strengthening and normalizing effect on the nervous system. When the reactivity of the nervous system is impaired, physical exercise leads to the normalization of its activity, balancing the process of excitation and inhibition in the cerebral cortex and improving the activity of the autonomic parts, and as a result, normalizing the functions of the digestive organs. Improving the function of the digestive organs with the help of physical exercises and massage is due to motor-visceral reflexes. It has been established that the receptors of muscles, tendons and joints serve not only to carry out movements, but also to regulate the most important autonomic functions, including the activity of the gastrointestinal tract.

Physical exercise activate tissue metabolism. Thanks to this, the nutrition of tissues and organs improves, the general tone of the body and the performance of patients increase. Influenced special exercises blood circulation in the abdominal organs improves and the amount of deposited blood decreases. This helps to subside inflammatory processes in the organs of the gastrointestinal tract and accelerate regeneration processes in them (for example, scarring of ulcers). Blood circulation improves at the same time in the pelvic organs. Exercises for muscles pelvic floor, preventing stagnation of blood in the rectum and hemorrhoidal veins, have a beneficial effect on pathological processes in this area.

By providing a general tonic effect on the body and improving the condition of the central nervous system and blood circulation, exercise therapy strengthens the abdominal muscles, promotes increased intestinal peristalsis and outflow of bile and gallbladder. The abdominal muscles play a significant role in fixing the abdominal organs and in weakening them internal organs shift downwards (so-called splanchnoptosis). An effective means of preventing and treating splanchnoptosis are special exercises in combination with massage aimed at strengthening the abdominal muscles.

Local the effect of exercise to the colon caused by changes in intra-abdominal pressure during contraction and relaxation of the abdominal muscles and breathing. When the abdominal muscles contract, intra-abdominal pressure increases and has a pressor effect on the colon; when the abdominal muscles relax, intra-abdominal pressure returns to its original level. Periodic changes in increasing and decreasing intra-abdominal pressure have a “massaging” effect on the large intestine and improve its functional state. Periodic changes in intra-abdominal pressure are also facilitated by deep breathing, during which the diaphragm contracts and thereby the volume of the abdominal cavity decreases; As a result, intra-abdominal pressure increases; when exhaling, the diaphragm relaxes, and therefore the volume of the abdominal cavity increases again and intra-abdominal pressure weakens. Combining breathing exercises with abdominal exercises provides a stronger effect on the colon.

Exercise therapy has a significant effect on the motor and secretory functions of the gastrointestinal tract. Large loads inhibit motility and secretion, moderates normalize them. Physical exercises during which pressure changes occur in the abdominal cavity (full deep breathing, bending the torso, bending the legs in hip joints etc.), help improve the outflow of bile from the gallbladder, which is extremely important for diseases of the liver, biliary tract and gallbladder.

Physical exercise remains the simplest means of increasing gallbladder drainage.

A decrease in general nutrition (hypotrophy) often complicates diseases of the digestive system. The main causes of malnutrition in these diseases are impaired digestion of food and absorption in the intestine due to morphological changes in the mucous membrane and malnutrition, when patients themselves limit it. The therapeutic effect of exercise therapy against the background of a balanced diet is determined by its stimulating effect on metabolism. The unconditional and conditioned reflex increase in metabolism is explained by the corrective influence of the nervous system on tissue trophism.

Exercise therapy technique

Contraindications To purpose means of exercise therapy: period of exacerbation of the disease - severe pain, severe dyspeptic disorders; general contraindications.

Motor mode represents the use and rational distribution various types the patient’s physical activity throughout the day, in a certain combination and sequence in relation to other factors of complex treatment.

Morning hygienic gymnastics pursues the goals of general development and strengthening of health, increasing efficiency. It helps hardening, promotes a more complete transition from an inhibited state to an alert state, and eliminates stagnation in various departments.

In morning hygienic exercises, a small (8-10) number of exercises are used, covering the main muscle groups; physical exercise should be simple.

Therapeutic gymnastics is one of the main forms of exercise therapy.

The basis of the private method of therapeutic gymnastics, as well as the general one, is systematicity, regularity, duration of classes, increasing physical activity during classes, individualization, and the use of special and breathing exercises.

In addition to general developmental exercises, special exercises are used for the abdominal and pelvic floor muscles, breathing exercises (static and dynamic), and voluntary muscle relaxation exercises.

Attention! Exercises for the abdominal muscles are excluded in the subacute period of the disease.

Exercises in voluntary muscle relaxation reduce excitatory processes in the central nervous system, help accelerate the recovery processes of working muscles, reduce the tone of not only the muscles involved in relaxation, but (reflexively) also the smooth muscles of the internal organs of the stomach and intestines, relieve spasms of the intestines, pylorus and sphincters.

The therapeutic effect of therapeutic exercises will be significantly higher if special physical exercises are performed by muscle groups receiving innervation from the same segments spinal cord, as the diseased organ (stomach C 3 -C 4 (from 3 to 4 cervical segments); liver, gall bladder C 3 -C 4, Th 6 -Th l0 (from 3 to 4 cervical and from 6 to 10 thoracic segments) , pancreas C 3 - C 4, Th 7 - Th 9 (from 3 to 4 cervical and from 7 to 9 thoracic segments).These are exercises involving the muscles of the neck, trapezius, muscles that lift the scapula, rhomboid major and minor, diaphragm, intercostal muscles, anterior abdominal wall, iliopsoas, obturator, muscles of the foot and lower leg.

For diseases of the digestive system, the effectiveness of therapeutic exercises largely depends on the choice of starting positions that allow differentiated regulation of intra-abdominal pressure.

The most commonly used starting position is lying with legs bent(on the left or right side, on the back); standing, kneeling, on all fours, standing and sitting.

The starting position lying down is recommended during an exacerbation and immediately after an exacerbation of the disease as the most gentle, promoting the least functional changes, providing the best conditions for performing breathing exercises (lying on your back with bent legs), and voluntary muscle relaxation. These starting positions are convenient for performing exercises for the abdominal muscles and pelvic floor.

The anatomical and topographic relationships of the gallbladder, common bile duct and duodenum allow us to recommend the initial position lying on the left side, standing on all fours, in which the outflow of bile towards the neck of the bladder and ampulla is carried out under the influence of hydrostatic pressure. Additionally, the outflow of bile in these initial positions is accelerated by an increase in intra-abdominal pressure when full of breath with an emphasis on the diaphragm and some involvement of the abdominal mouse.

The initial kneeling position (on all fours) is used if necessary to limit the impact on the abdominal muscles, to cause mechanical movement of the stomach and intestinal loops; the initial standing and sitting positions are used for the greatest impact on the digestive organs.

Physiotherapy in the aquatic environment carried out in pools with fresh or mineral water. Exercises are performed from a starting position lying down with floating devices or at the handrail, sitting on a hanging chair, standing and in motion.

Lesson duration is from 20 to 40 minutes. Water temperature 24-26 °C. The course of treatment consists of 12-15 procedures. Classes are conducted individually or in a small group.

Terrencourt on fresh air trains and strengthens the body, normalizes the psycho-emotional sphere. This is a natural physical exercise - walking.

Physical activity can be dosed by changing the distance, the angle of elevation (route number), the pace of walking (covering a given distance in a certain period of time), the number of stops for rest and their duration, the use of breathing exercises during the period of walking and rest, the prescription 1-2 or 3 walks a day, alternating training days with rest days.

Sport games from a physiological point of view, they represent complex forms of acyclic muscle activity, which significantly complicates their dosage. This deficiency is compensated by their high emotionality.

Gaming activity allows you to include and use large reserve capabilities of cardio-vascular system.

The listed forms of exercise therapy, sports exercises and massage can be included in the motor regimen of patients.

Approximate schemes of motor modes.

Low mode physicalwhat activity (gentle) adaptation restorations to extended mode loads are applied; stimulation of metabolic processes; combating congestion in the abdominal cavity; normalization of regenerative processes; a positive effect on the psycho-emotional sphere of patients and a moderate increase in the adaptation of the cardiovascular system to increasing physical stress. With a gentle regime, periods of rest prevail over periods of stress.

Contents of the regime: include balneo- and physiotherapeutic procedures. Morning hygienic gymnastics using a small group method with low load, duration 10-15 minutes, therapeutic gymnastics class density 40-50 %, LH in a small group method or individually, duration 20-25 minutes, lesson density 40-50%, dosed walks on flat terrain with a length of 0.5-1.5 km 1-2 times a day with a rest interval of at least 1 -2 hours, at a pace characteristic of the patient’s dynamic stereotype. Independent studies physical exercises 1-2 times a day, 6-8 special exercises. Sedentary games (croquet, bowling) up to 30 min.

Indications for the regimen: diseases of the gastrointestinal tract in the stage of fading exacerbation, organic damage to the cardiovascular system with symptoms of circulatory failure, a tendency to vascular crises, poor general condition (severe weakness, fatigue).

Mode with average physical activity (gentle training). Goal: restoration of adaptation to training loads. Regulation of excitation and inhibition processes in the central nervous system, normalization of autonomic functions. Stimulation of metabolic processes, fight against congestion in the abdominal cavity, improvement of regenerative processes.

Contents of the regime: include balneo- and physiotherapeutic procedures. Morning hygienic gymnastics using the group method with low load (duration 12-15 minutes, motor density 50-60%), therapeutic exercises with medium load (duration 25-30 minutes, 3-4 sessions per day for 5-10 minutes ). Dosed walks at a slow and medium pace with a length of up to 6 km and an elevation angle of up to 10° 1-2 times a day. Allowed to play croquet, bowling alley, table tennis, badminton according to simplified rules with low load, on average up to 40-60 minutes. Sport exercises(water and winter sport) with low load, dosed rowing, horse riding, skiing.

Indications for prescribing the regimen: chronic diseases of the gastrointestinal tract in the phase of complete remission, 1-3 years after cholecystectomy and gastrectomy, initial phenomena of organic damage to the cardiovascular system with compensation of blood circulation and the absence of heart rhythm disturbances. The regimen is also indicated for patients transferred from a gentle regimen.

Mode with high physical activity (training). Goal: maintaining performance at the highest possible level.

Mode content: The daily routine includes balneo- and physiotherapeutic procedures. Morning hygienic gymnastics in a group method with an average load (15-20 minutes, motor density 60-70%), therapeutic exercises with a heavy load using a special method (30-45 minutes, motor density 60-70%). Self-training of patients with special exercises 3-4 times a day. Measured walks at a slow pace along routes ranging from 10 to 20 km with an elevation angle of up to 20°. Participation in competitions according to simplified rules is allowed. Sports exercises (water and winter sports) with an average load. Physical activity takes precedence over rest and relaxation.

Indications for the regimen: chronic diseases of the gastrointestinal tract in the phase of stable remission with stable compensation of functions. The regimen is also prescribed to patients transferred from the gentle training regimen to the second half of the course of treatment, subject to positive dynamics. The duration of a patient’s stay in one or another mode of movement is not determined by a certain number of days. The attending physician transfers the patient from one regimen to another based on favorable changes in his clinical condition with adaptation of the cardiovascular system and the body as a whole to the previous movement mode. It is not necessary to prescribe all forms of exercise therapy in a new regime: a training effect can be achieved by increasing the load in only one form of exercise therapy.

THERAPEUTIC PHYSICAL ACTIVITY FOR DISEASES OF THE DIGESTIVE ORGANS. Diseases of the digestive system occupy a significant place in clinical medicine. Diseases of the digestive system often affect people of most working age, causing high rate temporary incapacity and disability.

In diseases of the digestive system, changes in motor, secretory and absorption functions are observed. Pathological processes of the gastrointestinal tract are in close relationship with each other and are caused by a violation of nervous regulation. As a result of a violation of the secretory function, gastritis, gastric and duodenal ulcers, etc. develop, and in case of a disorder of motor function - colitis, constipation, etc. The main means of treating diseases of the digestive system are diet therapy, medications, massage, movements (physical therapy, moderate physical activity, etc. .), physio- and hydrotherapy procedures.

Exercise therapy for this pathology has a general tonic effect, adjusts neurohumoral regulation, stimulates blood and lymph circulation in the abdominal organs, strengthens the abdominal muscles, helps normalize the evacuation and motor functions of the intestines, etc. The result of physical exercise depends on its type, dosage, rhythm and the pace of implementation, the stage of their application, the duration of the course, as well as their combination with diet and other medications.

Studies have shown that moderate exercise normalizes the secretory and evacuation functions of the stomach, and intense physical training- on the contrary, they oppress. The use of special exercises and segmental reflex massage helps to normalize impaired functions. Thus, exercises for the muscles of the abdominal wall and pelvic floor help well with chronic colitis, cholecystitis, dyskinesias, etc., and breathing exercises have a “massaging” effect on the internal organs, improving blood and lymph circulation in the abdominal cavity. At the same time, abdominal exercises, as studies have shown, sharply increase intra-abdominal pressure, so they are contraindicated in patients with exacerbation of gastric and duodenal ulcers, and spastic colitis.

Useful for such patients breathing exercises, relaxation exercises lying on your back with your legs bent at the knees and hips, or in the knee-elbow position.

Massage facilitates the secretion of bile by increasing blood and lymph circulation in the liver and abdominal organs. Physical exercises help normalize impaired functions in dyskinesia of the gastrointestinal tract and biliary tract. Thus, exercise therapy and massage provide positive influence on the abdominal organs, stimulate the regulatory mechanisms of the digestive system.

Gastritis Gastritis is an inflammation of the gastric mucosa, which can be acute or chronic. Acute gastritis is most often the result of taking substances that irritate the mucous membrane, most often alcohol, eating poor quality or unusual food, certain medications, foodborne illnesses, and acute poisoning. During mass examinations of the population of industrialized countries, approximately 50% of people, many of whom did not complain of changes in the stomach, show signs of gastritis (V.Kh. Vasilenko, A.P. Grebnev; K. Villako et al., etc.). It has also been established that oxygen starvation of the body, being an important pathogenetic factor, has a great influence on the course and outcome of many internal diseases.

Another thing is known: the glands of the gastric mucosa are very sensitive to oxygen deficiency. Prolonged hypoxia leads to atrophy of the gastric mucosa with the development of enzymatic and secretory insufficiency.

Hypoxia of the gastric mucosa is aggravated by blood redistribution during heavy physical activity. The main portion of blood is sent to vital organs (brain, heart, liver, as well as to muscles), while the exchange blood flow in the abdominal organs is reduced. Thus, hypoxia is the cause of chronic atrophic gastritis. Chronic gastritis is an inflammatory change in the gastric mucosa of an endogenous or exogenous nature. Characteristic signs of chronic gastritis are: unpleasant taste in the mouth, sour belching, nausea, especially in the morning, heaviness in the epigastrium, flatulence and pain resembling ulcers; with gastritis with secretory insufficiency, diarrhea is possible.

A major role in the occurrence of chronic gastritis is played by alcohol abuse, smoking, drugs, poor nutrition (chronic lack of animal proteins in food, vitamins B, A, C, E) and irregularity (dietary disorder) of food intake. Chronic gastritis is often caused by intense physical activity, including sports.

Gastritis is divided (taking into account the secretory function of the stomach) into gastritis with secretory insufficiency; gastritis with increased secretion and acidity; gastritis with normal secretory function. Athletes often experience gastritis with increased secretion and acidity, which often develops into peptic ulcer disease.

Most often, chronic gastritis with high acidity occurs in men. Symptoms: heartburn, sour belching, burning sensation, pressure and heaviness in the epigastric region. When palpating the abdomen, moderate pain is noted; sometimes there is a neurasthenic syndrome (increased irritability, bad dream, fatigue, etc.) Diet therapy, drug therapy, vitamins and other means are used for treatment. Exercise therapy, walking, skiing, swimming, and cycling are recommended.

During sanatorium-resort treatment: swimming, walking and running along the seashore, games on the seashore, diet, taking an oxygen cocktail, exercise therapy, etc. PH includes general developmental and breathing exercises, relaxation exercises. For pain symptoms, cryomassage of the abdominal wall is indicated. However, exercises for the abdominal muscles are contraindicated. Walking, contrast showers, lying down LH (breathing exercises, exercises for the distal parts) are useful lower limbs). Objectives of massage: to provide an analgesic effect; normalize the secretory and motor functions of the stomach; activate blood and lymph circulation; eliminate the usually existing venous congestion; stimulate intestinal function.

Finish the massage of the abdominal wall with planar stroking and diaphragmatic breathing. Duration of massage is 10-15 minutes. Biliary dyskinesia Biliary dyskinesia is characterized by a disorder of the motor function of individual parts of the biliary system, including the sphincter of Oddi. This is facilitated by various autonomic nervous disorders.

Biliary dyskinesia is initial stage in the pathogenesis of other diseases of the biliary tract, contributing to the formation of gallstones and the development of infection. It is often combined with other functional disorders - duodenal dyskinesia, changes in the function of the stomach, intestines, and pancreas. With a spastic, or hyperkinetic, gallbladder, short-term pain is noted in the right hypochondrium and epigastric region.

An atonic, or hypokinetic, gallbladder is characterized by dull, prolonged pain after eating, which intensifies when the patient sits for a long time. Evacuation of bile is slowed down. Dyskinesias are quite common in athletes (cyclists, ski racers, stayer runners, etc.). The hyperkinetic form of dyskinesia is characterized by paroxysmal pain (biliary colic), which occurs after physical exertion (overload) and is often accompanied by nausea, vomiting, bowel dysfunction, as well as irritability, headache, and deterioration of the general condition.

Hypokinetic dyskinesia is manifested by periodically occurring pain and a feeling of fullness in the right hypochondrium, sometimes by dyspeptic symptoms and deterioration of the general condition. Complex treatment includes massage, LH, diet therapy, drinking mineral waters, physiotherapy and hydrotherapy, drug therapy, herbal medicine and other remedies.

LH consists of general developmental and breathing exercises; great importance has a choice of starting position. Best conditions for blood circulation in the liver, formation and secretion of bile are created in the supine position. To enhance the influence of the diaphragm, you can use breathing exercises while lying on your right side, since this increases the excursion of its right dome. In addition, LH is also performed while standing on the knees, as well as knee-elbow, which help relax the abdominal press and unload the spine, allowing you to perform exercises with raising and adducting the legs without sudden changes in intra-abdominal pressure.

In the hypokinetic form of dyskinesia, PH is performed lying on the back, on the left and right side, kneeling, kneeling with hands resting on the floor, sitting and standing. Perform general developmental and breathing exercises with gradually increasing amplitude and tempo of movements. The LH complex also includes abdominal exercises, walking; “belly breathing” helps reduce (or eliminate) pain.

Duration of classes is 20-30 minutes. During the period of complete remission, games, skiing, rowing, skating, cycling, swimming, etc. are recommended. In the hyperkinetic form of dyskinesia, PH is performed lying on the back, right and left side. Includes general developmental, breathing and relaxation exercises. Abdominal exercises, exercises with equipment (dumbbells, medicine balls), as well as tension and breath holding.

The pace of the exercises is slow and medium. Duration of classes is 15-20 minutes. During the period of complete remission - dosed walking, skiing, swimming, occupational therapy, ice skating, etc. The objectives of massage: normalization of the psycho-emotional state and function of the biliary tract, analgesic effect, elimination of congestion in the gallbladder. Massage technique. First, massage is performed on the collar area and back (segmental zones of the VIII-X thoracic and I-II lumbar vertebrae, especially on the right) using segmental techniques.

The massage is performed in a sitting position. Then, while lying on your back, massage your stomach and oblique abdominal muscles. The procedure is completed by squeezing the lower segments of the lungs (as the patient exhales). Repeat 3-5 times, then ask the patient to “breathe with the stomach” for 1-2 minutes (legs are bent at the knees and hip joints). The following techniques are excluded: chopping, tapping and deep kneading (especially in the area of the right hypochondrium). The duration of the procedure is 8-12 minutes. A course of 10-15 procedures.

End of work -

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Diseases of the digestive system occupy a significant place in clinical medicine. Diseases of the digestive system often affect people of the most working age, causing a high rate of temporary disability and disability.

The location and general anatomy of the main parts of the digestive tract are shown in Fig. 83. The close anatomical and physiological connection between the digestive organs makes it impossible to separately treat one or another organ in case of its disease.

As a result of impaired secretory function, gastritis, gastric and duodenal ulcers, etc. develop, and in case of motor function disorder, colitis, constipation, etc.

The main means of treating diseases of the digestive system are diet therapy, medications, massage, movements (physical therapy, moderate physical activity, etc.), physical and hydrotherapy procedures. Exercise therapy for this pathology has a general tonic effect, adjusts neurohumoral regulation, stimulates blood and lymph circulation in the abdominal organs, strengthens the abdominal muscles, helps normalize the evacuation and motor functions of the intestines, etc.

The result of the effects of physical exercise depends on its type, dosage, rhythm and tempo of implementation, on the stage of its application, the duration of the course, as well as on its combination with diet and other therapeutic agents.

Studies have shown that moderate physical exercise normalizes the secretory and evacuation functions of the stomach, while intense physical training, on the contrary, depresses it. The use of special exercises and segmental reflex massage helps to normalize impaired functions. Thus, exercises for the muscles of the abdominal wall and pelvic floor help well with chronic colitis, cholecystitis, dyskinesias, etc., and breathing exercises have a “massaging” effect on the internal organs, improving blood and lymph circulation in the abdominal cavity. At the same time, abdominal exercises, as studies have shown, sharply increase intra-abdominal pressure, so they are contraindicated in patients with exacerbation of gastric and duodenal ulcers, and spastic colitis. Such patients benefit from breathing exercises, relaxation exercises lying on the back with legs bent at the knees and hips, or in the knee-elbow position.

Rice. 83. Organs of the thoracic and abdominal cavities: 1 - larynx; 2 -

windpipe; 3 - upper lobe of the left lung; 4 - pulmonary trunk; 5 - heart; b- diaphragm; 7 - stomach; 8 - spleen; 9 - transverse colon; 10 - small intestine; 11 - sigmoid colon; 12 - bladder; 13 - cecum; 14 - ascending colon; 15 - gallbladder; 16 - liver; 17 - upper lobe of the right lung; 18 - aorta; 19 - brachiocephalic vein; 20 - left subclavian vein; 21 - left internal jugular vein; 22 - right common carotid artery
Massage facilitates the secretion of bile (V.I. Dubrovsky, 1973, 1985) by increasing blood and lymph circulation in the liver and abdominal organs. Physical exercises help normalize impaired functions in dyskinesia of the gastrointestinal tract and biliary tract.

Thus, exercise therapy and massage have a positive effect on the abdominal organs and stimulate the regulatory mechanisms of the digestive system.
Gastritis
Gastritis is an inflammation of the gastric mucosa, which can be acute or chronic. Acute gastritis is most often the result of taking substances that irritate the mucous membrane, most often alcohol, eating poor quality or unusual food, certain medications, foodborne illnesses, and acute poisoning.

During mass examinations of the population of industrialized countries, approximately 50% of people, many of whom did not complain of changes in the stomach, show signs of gastritis (V.Kh. Vasilenko, A.P. Grebnev; K. Villako et al., etc. ).

It has also been established that oxygen starvation of the body, being an important pathogenetic factor, has a great influence on the course and outcome of many internal diseases. Another thing is known: the glands of the gastric mucosa are very sensitive to oxygen deficiency. Prolonged hypoxia leads to atrophy of the gastric mucosa with the development of enzymatic and secretory insufficiency. Hypoxia of the gastric mucosa is aggravated by blood redistribution during heavy physical activity. The main portion of blood is sent to vital organs (brain, heart, liver, as well as muscles), while the exchange blood flow in the abdominal organs is reduced (M.M. Mirrakhimov, 1975).

Thus, hypoxia is the cause of chronic atrophic gastritis (E.K. Rychkova, T.N. Sauchikova, 1973, etc.).

^ Chronic gastritis - inflammatory change in the gastric mucosa of an endogenous or exogenous nature.

Characteristic signs of chronic gastritis are: unpleasant taste in the mouth, sour belching, nausea, especially in the morning, heaviness in the epigastrium, flatulence and pain resembling ulcers; with gastritis with secretory insufficiency, diarrhea is possible.

Diet therapy, drug therapy, vitamins and other means are used for treatment. Exercise therapy, walking, skiing, swimming, and cycling are recommended. During sanatorium-resort treatment: swimming, walking and running along the seashore, playing on the seashore, diet, taking an oxygen cocktail, exercise therapy, etc.

LH includes general developmental and breathing exercises, relaxation exercises. For pain symptoms, cryomassage of the abdominal wall is indicated. However, exercises for the abdominal muscles are contraindicated. Walking, contrast showers, lying down exercises (breathing exercises, exercises for the distal parts of the lower extremities) are useful.

Objectives of massage: to provide an analgesic effect; normalize the secretory and motor functions of the stomach; activate blood and lymph circulation; eliminate the usually existing venous congestion; stimulate intestinal function.

Massage technique. Abdominal massage is performed with maximum relaxation of the abdominal wall muscles. Planar stroking, rubbing, kneading the muscles of the abdominal wall, oblique abdominal muscles, and vibration are used. Then, along the course of the large intestine (starting from its ascending part), stroking is carried out with the fingertips of the right hand. Stroking techniques are repeated 4-6 times, after which several superficial circular strokes are made to give the abdominal wall a rest, and then tapping with the fingertips along the intestine and shaking it is carried out to influence its wall. Finish the massage of the abdominal wall with planar stroking and diaphragmatic breathing. Duration of massage is 10-15 minutes.
^ Peptic ulcer of the stomach and duodenum
Factors contributing to the occurrence of peptic ulcers are various disorders of the nervous system; in a number of patients, hereditary predisposition may be important, as well as neuropsychic overstrain of the central nervous system and its peripheral parts, dietary errors, alcohol abuse, spicy food, chronic diseases of the gastrointestinal tract and other factors.

Peptic ulcer of the stomach and duodenum in most patients was preceded by complaints of sour belching and heartburn, nausea and other symptoms. But the main symptom of peptic ulcer disease is pain, which is especially intensified in spring and autumn. Mild excitability, irritability, and sleep disturbances are also noted.

Comprehensive rehabilitation includes: massage, physical therapy, diet therapy, physiotherapy and hydrotherapy, drinking mineral water and other therapeutic agents. LH (Fig. 84) is used during the period of remission, the absence of dyspeptic and pain symptoms, with normal levels of ESR, hemoglobin and leukocytes, as well as in the absence of occult blood in the feces. If pain occurs in the epigastric region, cryomassage is indicated, excluding techniques that cause muscle tension in the abdominal press. The exercises are performed lying down, at a slow pace and monotonous rhythm, accompanied by music. Duration 8-10 minutes, then take a contrast shower.

Rice. 84.Approximate complex LH for gastric ulcer and

duodenum
Sanatorium-resort treatment is recommended (Crimea, etc.), during which: walks, swimming, games; in winter - skiing, ice skating, etc.; diet therapy, drinking mineral water, taking vitamins, ultraviolet radiation, contrast shower.

In the phase of complete remission, PH is performed standing, sitting and lying down. Includes exercises with gymnastic stick, balls, dumbbells, training on exercise machines (or block machines), visiting a sauna (bath) and long walking at a calm pace.

Objectives of massage: normalization of the psycho-emotional state, sleep, pain relief, acceleration of oxidative metabolic processes and regeneration of the mucous membrane.

Massage technique. Massage of the collar area, back (segmental effect on the cervicothoracic spine) and abdominal wall. Massage of the abdominal wall is carried out during the period of remission. Chopping, beating and vibration are excluded. Duration of massage is 10-15 minutes. A course of 15-20 procedures. There are 3-4 courses per year. It is advisable to carry out the massage in a darkened room, accompanied by color music; then - taking an oxygen cocktail (the cocktail should include various herbal decoctions).
^ Biliary dyskinesia
Biliary dyskinesias are characterized by a disorder of the motor function of individual parts of the biliary system, including the sphincter of Oddi. This is facilitated by various autonomic nervous disorders. Biliary dyskinesia is the initial stage in the pathogenesis of other diseases of the biliary tract, contributing to the formation of gallstones and the development of infection. It is often combined with other functional disorders - duodenal dyskinesia, changes in the function of the stomach, intestines, and pancreas.

With a spastic, or hyperkinetic, gallbladder, short-term pain is noted in the right hypochondrium and epigastric region.

An atonic, or hypokinetic, gallbladder is characterized by dull, prolonged pain after eating, which intensifies when the patient sits for a long time. Evacuation of bile is slowed down.

Dyskinesias are quite common in athletes (cyclists, cross-country skiers, distance runners, etc.).

^ For the hyperkinetic form of dyskinesia characterized by paroxysmal pain (biliary colic), which occurs after physical exertion (overload) and is often accompanied by nausea, vomiting, bowel dysfunction, as well as irritability, headache, and deterioration of general condition.

^ Hypokinetic dyskinesia manifested by periodically occurring pain and a feeling of fullness in the right hypochondrium, sometimes by dyspeptic symptoms and deterioration of the general condition.

Complex treatment includes massage, physical therapy, diet therapy, drinking mineral waters, physiotherapy and hydrotherapy, drug therapy, herbal medicine and other remedies.

LH consists of general developmental and breathing exercises; The choice of starting position is of great importance. The best conditions for blood circulation in the liver, formation and secretion of bile are created in a lying position. To enhance the influence of the diaphragm, you can use breathing exercises while lying on your right side, since this increases the excursion of its right dome. In addition, LH is also performed while standing on the knees, as well as knee-elbow, which help relax the abdominal press and unload the spine, allowing you to perform exercises with raising and adducting the legs without sudden changes in intra-abdominal pressure.

In the hyperkinetic form of dyskinesia, PH is performed lying on the back, right and left side. Includes general developmental, breathing and relaxation exercises. Abdominal exercises, exercises with equipment (dumbbells, medicine balls), as well as straining and holding your breath are not recommended. The pace of the exercises is slow and medium. Duration of classes is 15-20 minutes. During the period of complete remission - dosed walking, skiing, swimming, occupational therapy, ice skating, etc.

Objectives of massage: normalization of the psycho-emotional state and function of the biliary tract, analgesic effect, elimination of congestion in the gallbladder.

Massage technique. First, massage is performed on the collar area and back (segmental zones of the VIII-X thoracic and I-II lumbar vertebrae, especially on the right) using segmental techniques. The massage is performed in a sitting position. Then, while lying on your back, massage your stomach and oblique abdominal muscles. The procedure is completed by squeezing the lower segments of the lungs (as the patient exhales). Repeat 3-5 times, then ask the patient to “breathe with the stomach” for 1-2 minutes (the legs are bent at the knee and hip joints). The following techniques are excluded: chopping, tapping and deep kneading (especially in the area of the right hypochondrium). The duration of the procedure is 8-12 minutes. A course of 10-15 procedures.
^ Chronic cholecystitis
Chronic cholecystitis is a chronic inflammation of the gallbladder. It can occur after acute cholecystitis, but more often it develops independently and gradually. The occurrence of chronic cholecystitis is promoted by various bacterial flora. There are cholecystitis of toxic and allergic nature.

An important predisposing factor in the development of cholecystitis is stagnation of bile in the gallbladder, which can be caused by gallstones, compression and kinks of the bile ducts, dyskinesia of the gallbladder and biliary tract, arising under the influence of various emotional stress, endocrine and autonomic disorders, etc. Stagnation of bile in the gallbladder Rare meals, heavy physical activity, hypothermia, etc. also contribute. Dull, aching pain in the area of the right hypochondrium is characteristic. The pain radiates upward to the area of the right shoulder, neck and right shoulder blade. Dyspeptic symptoms are common: bitterness and metallic taste in the mouth, nausea, flatulence, defecation disorders. Irritability and insomnia are also noted.

Palpation of the abdomen reveals pain in the area of projection of the gallbladder onto the anterior abdominal wall and slight muscular resistance of the abdominal wall. The liver may be slightly enlarged, with a dense and painful edge on palpation (with the development of chronic hepatitis, cholangitis).

Along with complex treatment (diet, drug therapy, etc.), massage, LH (Fig. 85), swimming, skiing, etc. are prescribed.

Indications for massage: non-calculous diseases of the gallbladder, combined with a decrease in motor activity and tone of the gallbladder. Massage is carried out during the period of remission (outside the exacerbation stage).

Objectives of massage: improvement of bile excretory function, bile outflow; spasm relief; increased tone of the gallbladder and sphincters.

Massage technique. They influence the reflexogenic zones of the spine on the left and the Boas zone, which projects onto the area of the end of the XI-XII ribs on the right and is organ-specific for the gallbladder. In this projection, a zone of hyperesthesia (increased tactile sensitivity) is revealed due to the pathological trophic viscerocutaneous reflex. Apply stroking, rubbing and kneading. When influencing the reflexogenic zone of the spine, segmental massage techniques (“saw”, “drilling”, “shifting”, etc.) are used in combination with stroking and rubbing. Duration of massage is 10-15 minutes.

After the massage, the secretory and excretory function of such an important organ as the liver increases significantly (p Constipation
Constipation can be functional or organic in origin. Functional disorders of intestinal motor function include spastic and atonic states.

Rice. 85. Approximate LH complex for cholecystitis
The pathogenesis of constipation is associated with reflex effects from the central nervous system or changes in the intramural innervation apparatus of the intestine, a decrease in the production of cholinergic substances and an increase in andrenergic substances, disturbances in electrolyte-mineral metabolism, which causes the development of intestinal dyskinesia and constipation.

Spastic and atonic colitis are detected.

Massage, physical therapy (Fig. 86), hydrokinesitherapy, swimming, rowing, etc. are indicated.

The goals of the massage: for spastic colitis - to achieve an antispastic effect, normalization of reflex connections, blood circulation and intestinal motility; for atonic colitis - stimulation of the parasympathetic nervous system, increased blood and lymph circulation in the intestines, normalization of intestinal motility.

Massage technique. To stimulate the motor function of the large intestine when it is lethargic, massage is performed lumbar region, sacrum, gluteal muscles, belly, groin area, thigh muscles. The following techniques are used: stroking, rubbing, kneading and, to a greater extent, vibration. For spastic colitis, vibration techniques are excluded. Duration of massage is 5–10 minutes. There are 15–20 procedures per course. 2-3 courses per year.

Rice. 86. Approximate LH complex for colitis
When colitis is detected in women, gynecological massage is indicated. Duration 3–5 min. There are 5–8 procedures per course (performed every other day or two).
Gastroptosis
Gastroptosis - prolapse of the stomach. Among the reasons causing this disease are weakening of the abdominal muscles, significant weight loss, asthenic condition, physical inactivity, etc. Patients with prolapse of the stomach are characterized by complaints of a feeling of heaviness, pressure and a feeling of fullness in the epigastric region after eating, belching of air, protrusion of the lower abdomen, flatulence, etc. Complex treatment includes massage, LH, swimming, physiotherapy, diet therapy. LH (Fig. 87) is performed lying on the back (with the pelvis raised), on all fours, in the knee-elbow position. They include general developmental exercises, breathing (“diaphragmatic” breathing), exercises with a rubber shock absorber, dumbbells, hydrokinesitherapy (swimming with a board, with fins, with spatulas, games in the pool), cryomassage of the abdomen. Subsequently, vibration massage of the back, gluteal muscles, and lower extremities is used for 10-15 minutes. A course of 15-20 procedures.

Rice. 87. Approximate LH complex for gastroptosis