Physiotherapy methods to improve the physical condition of athletes. Sports physiotherapist Oleg Semenovich Kulinenkov, Natalya Evgenievna Grechina, Dmitry Olegovich Kulinenkov Physiotherapy in sports practice

Recently, among the medical and biological means of restoring sports performance, great importance is attached to physical factors. Physiotherapists are increasingly involved in the health care of athletes. So, for example, among medical workers serving Olympic Games, more than half were physiotherapists. This is caused not only by the insufficient efficiency of drug therapy in sports medicine, but also by advances in the study of the influence of natural factors, natural and preformed, in the development of effective methods and methods of their application in the treatment of athletes.

In contrast to the previously widespread opinion about physical factors as nonspecific stimuli, the presence in the action of each of them and a specific component, which manifests itself to the greatest extent when using small doses, has now been proven. The most important result of this provision was an orientation towards a specific component of the action of physical factors, and, consequently, large doses, which led to a reduction in contraindications and a significant expansion of indications for the use of physical factors.

This opens up broad prospects for studying the possibility of using physical factors that accelerate and improve the course of recovery processes in the body, in the preparation of athletes highly qualified.

The use of physiotherapy and balneotherapy methods for restoring sports performance has a number of significant advantages in comparison with many other medical and biological means. These methods are physiological, have no side effects, including allergenic effects, are highly effective, amenable to individual dosage, they can be used to carry out both local and general restorative measures.

Physical factors, being a complex complex stimulus acting on the receptor zones of the body, change the physicochemical processes in the tissues, promote better oxygen utilization and the fastest elimination of decay products. When properly prescribed, taking into account the mechanism of action of each factor, the functional state of the athlete's body and the tasks facing him, they have a positive effect on the state of the nervous system, on individual functions of the athlete's body, increase his performance and resistance to adverse environmental influences, accelerate recovery processes after intense physical activity.

When choosing and prescribing physiotherapeutic agents to restore an athlete's working capacity, one should be guided by the general principles of carrying out rehabilitation measures (pedagogical, psychological, medico-biological). First of all, it should be remembered that any recovery activity will be effective only in combination with the optimal training regimen and the lifestyle of athletes.

When using physical factors, the purpose of their appointment should be taken into account: increasing or restoring working capacity, using the factor for therapeutic or prophylactic purposes. In the preparatory period, when an athlete has loads of large volume and intensity, it is recommended to carry out recovery measures, which, by promoting the acceleration of recovery processes, create more favorable conditions for subsequent training and increase the athlete's performance in general. During the competitive period, especially immediately before the start, the use of physical factors is mainly aimed at mobilizing systems that provide the highest sports result. It should be borne in mind that the effectiveness of rehabilitation measures depends on their compliance with the functional state of the athlete's body and the specifics of the sport. It is necessary to know which functional systems are more loaded and recover more slowly with a certain nature of work in a particular sport, to take into account the heterochronism and phasicity of recovery processes in the athlete's body. A rational combination of methods of general and local impact is recommended: the former have a nonspecific restorative effect; the latter help to relieve fatigue of certain muscle groups by improving blood circulation and metabolic processes in tissues.

The conducted observations show that carbon dioxide baths have a beneficial effect on the regulatory mechanisms of activity. of cardio-vascular system, first of all, the cardiac hemodynamic factor, increasing the stroke output of the heart. When used to restore sports performance, a decrease in energy costs for the activity of the cardiovascular system was noted due to a decrease in heart rate, redistribution of blood flow in working muscles, which was accompanied by the elimination of metabolic acidosis.

The use of sodium chloride baths contributed to a decrease in the increased tone of the sympathetic nervous system of athletes in a state of fatigue after intense training loads, increased physical performance and aerobic energy supply capabilities. The simplicity and availability of sodium chloride baths procedures, their high efficiency makes it possible to recommend them for the restoration of athletes' performance.

A highly effective method of restoring sports performance is the combination in one procedure of a hydroelectric bath of underwater jet massage. Such a combined procedure leads to a rapid recovery of the main functional systems of the athlete's body, and according to some indicators (hemodynamics, muscle tone, orthostatic test, the content of lactic acid in the blood) is also observed "over-recovery", which indicates that the athlete's body reaches a higher functional level. Obviously, the effect of such an effect by several physical factors is carried out through the simultaneous inclusion of a number of extra- and proprioceptors, which helps to reduce the heterochronism of recovery processes. As a result, almost simultaneously and to a sufficient extent, all the links of the energy supply of muscular activity are restored: the cardiovascular and sympathetic-adrenal systems, the neuromuscular apparatus, and metabolic processes.

In general, it was noted that balneological factors are a means of restoring general action, significantly increasing the athletes' working capacity.

For a number of years, the Central Research Institute of Balneology and Physiotherapy has been developing methods for restoring sports performance using a rectangular pulse current of low frequency (with the occipital location of the electrodes), which causes electrosleep. The leading role in the mechanism of action of electrosleep is played by the direct influence of a rectangular impulse current mainly on the subcortical-brainstem parts of the brain (hypothalamus, pituitary gland, reticular formation), i.e. on important vegetative-endocrine centers of regulation of various physiological functions of the body. As a result, the electrosleep procedure increases the function of external respiration, redox processes (tissue respiration), increases blood oxygen saturation, which helps to optimize energy processes. All this helps to accelerate the recovery of the athlete's functionality. Electrosleep procedures with a pulse frequency of 10-20 Hz normalize hemodynamic parameters, reduce the increased tone of the sympathetic nervous system, and improve the indicators of the functional state of the central nervous system. Indications for the appointment of these procedures are fatigue, overtraining, emotional stress, and sleep disturbance.

The use of the technique of electrosleep with a higher frequency of impulses, especially 90-100 Hz, improves the mechanisms of regulation of autonomic functions and contributes to the growth of the athlete's fitness level. These procedures, carried out 30-60 minutes before training, increase the athlete's performance.

In general, it was noted that impulse currents of low frequency according to the method of electrosleep have a pronounced sedative and anti-stress effect and are shown during the period of increased physical and psychological stress, especially during the competitive period.

Sinusoidal modulated currents (CMT) generated by the "Amplipulse" apparatus are an effective method of restoring and increasing sports performance. As the work of scientists of our institute has shown, these effects irritate nerve receptors and reduce a large number of muscle fibrils, which provides micromassage of peripheral vessels, improves blood circulation in muscles, and promotes the development of collaterals. Thus, the course of metabolic processes in tired muscles is stimulated, the content of ribonucleic acid in their fibers increases, the plastic materials of the muscles are consumed more economically. CMTs also have significant analgesic properties. They have not only a local effect on tired muscles, but also a pronounced positive effect on the state of the athlete's cardiovascular system, contributing to his transition to a more economical level of functioning.

Repeated course impacts of the CMT during preparatory period training cycle increase the fitness of athletes. Carrying out these procedures in a stimulation mode 10-15 minutes before the start makes it possible to improve the performance of athletes directly during the pre-start preparation.

At present, we are paying great attention to studying the possibilities of using electromagnetic oscillations of ultrahigh frequency (UHF) of the decimeter range when acting on the area of muscles that are most tired after training and on the area of projection of the endocrine glands (adrenal glands and thyroid gland). In the experimental and clinical work carried out at the institute, new approaches have been developed in the regulation of autoimmune and hormonal disorders when exposed to decimeter waves (UHF) on the endocrine glands. The immunostimulating effect of UHF when exposed to the thyroid gland and the immunocorrective effect when exposed to the projection of the adrenal glands was also established.

On the basis of these data, it is proposed to use the effect of UHF on the projection of the adrenal glands during the preparatory period of the training cycle, and on the thyroid gland during the competitive period.

Research on the use of physical factors in high-performance sports has made it possible to develop over 15 methodological recommendations, which have been introduced into the practice of training athletes of national teams in various sports. The practical use of these techniques at various sports bases has shown their effectiveness, contributed to the achievement of high sports results.

Oleg Semenovich Kulinenkov, Natalya Evgenievna Grechina, Dmitry Olegovich Kulinenkov

Physiotherapy in sports practice

SPORT Publishing House is a member of the International Sports Publishers Association (WSPA)

List of abbreviations

AIT - aeroionotherapy

VIMT - High Intensity Magnetic Therapy

HBO - hyperbaric oxygen therapy

HT - halotherapy

DDT - diadynamic currents

DUV - long-wave ultraviolet radiation

IR - infrared radiation

EHF - extremely high-frequency currents

KUF - shortwave ultraviolet radiation

LI (LT) - laser radiation (laser therapy)

LOD - local negative pressure

LOK - laser blood irradiation

MCP - muscle counterpulsation

MLT - Magnetic Laser Therapy

MT - magnetotherapy

NE - low-frequency electrotherapy

OACT - general aerocryotherapy

OMT - general magnetotherapy

CMT - sinusoidal modulated currents (amplipulse)

SUF - medium-wave ultraviolet radiation

UHF - ultra high frequency current

UFO - ultraviolet irradiation

EECP - enhanced external counterpulsation

EMF - electromagnetic field

Foreword

Various physical factors of influence on the human body can be effective means of restoring and improving the performance of an athlete.

Methods and techniques for influencing a person by physical factors have been developed for over 200 years. Currently, the methods have been developed in sufficient detail and are successfully applied in clinical practice. This monograph will focus on the practical application of physical factors affecting the athlete's body, his psyche in order to improve professional qualities and as a means of correcting the factors limiting athletic performance.

Modern sport is characterized by physical and emotional-mental stress, bordering on the individual physiological capabilities of the athlete. Timely, individual, methodically accurate use of physiotherapy, which sometimes cannot be replaced by anything, is of great importance for professionals and sports amateurs.

Physiotherapy methods are proposed to improve performance, eliminate specific, pathological conditions characteristic of sports activities in the same methodological way as in the pharmacotherapy of sports (O.S. Kulinenkov, 2000–2016), and can complement each other.

Under the influence of the effects of physical factors (in appropriate doses, taking into account the initial state, the reactivity of the body), metabolic processes, the general background of the body's vital activity are improved, various effects are manifested that have therapeutic value: general stimulation, anti-inflammatory, desensitizing effect, normalization of neuro-vegetative relationships, improvement of basic nervous processes. In the described effect of physical factors on the body, the principle of physiotherapy as a nonspecific therapy is reflected.

Monitoring of loads in elite sports shows their limit values for almost all age categories. In these conditions, the friendly work of a sports physiologist (trainer) and a sports doctor with his knowledge of diet, physiotherapy, pharmacology and other methods of sportsman's recovery should acquire great importance in training a high-class athlete and an amateur athlete; who owns the methods of biochemical control, functional diagnostics, etc. and, of course, has clinical skills.

Comprehensive medical support for a specific athlete in connection with the loads used and a certain individual state of health is an indispensable condition for maintaining and increasing his level, prolonging sports longevity.

Novice athletes and amateur athletes need more medical attention. The fact is that amateurs (athletes), imitating and adopting the methods of physical activity professional sports, very quickly acquire "sores", to which a professional athlete has been going for many years.

Probably, the days are gone when massage and sauna were the main means of recovery in sports. World practice has long and far advanced in the use of various physical factors in the activity of sports, being a locomotive in the promotion of new health-improving methods.

At the same time, in sports, recovery processes have been skewed towards the increasing use of pharmacological agents.

Physiotherapy in the practice of sports is designed to squeeze the use of pharmacology from some positions: to avoid polypharmacy, to reduce the side effects of pharmaceuticals, to replace some drugs that cannot be used according to doping criteria, etc.

In the process of using physiotherapy, a combination of 3-4 procedures is possible without contraindications and side effects, which increases their potential as restorative agents.

Perhaps one should immediately warn about the need to refrain from using physiotherapeutic methods of direct exposure to the brain directly with procedures such as transcranial electroanalgesia, electrical sleep therapy, general galvanization of the brain, etc. , less traumatic, since the choice is wide. We do not prefer pharmacological drugs with a more stressful spectrum of side effects and complications. And the head - the head must be protected, especially for athletes. In sports, the best result is achieved by the one whose head works better. “We are just on the way to understanding the functioning of the brain,” writes Academician N. P. Bekhtereva (2008).

The use of physiotherapy becomes less problematic in conditions when more and more compact physiotherapy devices (sometimes at the household level) appear than in the days of bulky stationary devices. The sports doctor's own mobile physiotherapy room is becoming a reality. At the same time, large formats of technical devices for physical exposure have become ubiquitous in commercial operation and have become more available in use: cryotherapy chambers, hydroxy / hypoxic therapy chambers, etc.

The procedures that the athlete (coach) can carry out himself, using the health-improving factors of nature (climatotherapy) or the simplest physiotherapy devices and devices, introduced into everyday (“home”) practice, are described in more detail.

The formulation and interpretation of the principles of prescribing physiotherapy methods, the individualization of the parameters and gradations of individual techniques are presented in the original author's presentation.

I. Fundamentals of Sports Physiotherapy

The specifics of physiotherapy in sports practice

First of all, the doctor's appointment of a program of restorative measures, therapeutic effects by physical factors is coordinated with the athlete's coach, since the training process and restoration of working capacity should be planned as a single process.

The trainer and doctor should take into account the following points in their work.

Physical factors used by athletes for rehabilitation and / or therapeutic purposes are an additional burden for them. Therefore, when prescribing recovery measures at any training stage, it is necessary to take into account the degree of fatigue of an athlete and calculate the total load taking this factor into account.

Physical factors have an active effect on the body. They can not only reduce fatigue, accelerate recovery processes, increase resistance to physical stress, but also lead to a decrease in the body's reserve capabilities, a decrease in its sports performance, and cause an exacerbation of the pathological process.

With the development of severe fatigue in the training process or the appearance of signs of maladjustment and insufficient capabilities of the body in recovery, the procedures of general influence are canceled (or sharply limited) as creating an additional load, leaving or prescribing methods of local action for recovery purposes. In these cases, low-intensity physical factors are chosen as having a milder effect on the body, reducing their amplitude and frequency of use.

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Oleg Semenovich Kulinenkov, Natalya Evgenievna Grechina, Dmitry Olegovich Kulinenkov
Physiotherapy in sports practice

SPORT Publishing House is a member of the International Sports Publishers Association (WSPA)

All rights reserved. No part of this book may be reproduced in any form whatsoever without the written permission of the copyright holders. Legal support for copyright is provided by a law firm.

© Kulinenkov O.S., Grechina N.E., Kulinenkov D.O., 2017

© Original layout, design publishing house "Sport", 2017

List of abbreviations

AIT - aeroionotherapy

VIMT - High Intensity Magnetic Therapy

HBO - hyperbaric oxygen therapy

HT - halotherapy

DDT - diadynamic currents

DUV - long-wave ultraviolet radiation

IR - infrared radiation

EHF - extremely high-frequency currents

KUF - shortwave ultraviolet radiation

LI (LT) - laser radiation (laser therapy)

LOD - local negative pressure

LOK - laser blood irradiation

MCP - muscle counterpulsation

MLT - Magnetic Laser Therapy

MT - magnetotherapy

NE - low-frequency electrotherapy

OACT - general aerocryotherapy

OMT - general magnetotherapy

CMT - sinusoidal modulated currents (amplipulse)

SUF - medium-wave ultraviolet radiation

UHF - ultra high frequency current

UFO - ultraviolet irradiation

EECP - enhanced external counterpulsation

EMF - electromagnetic field

Foreword

Various physical factors of influence on the human body can be effective means of restoring and improving the performance of an athlete.

Physiotherapy methods have been proposed to improve performance, eliminate specific, pathological conditions characteristic of sports activities in the same methodological way as in sports pharmacotherapy (O.S. Kulinenkov, 2000–2016), and can complement each other.

Novice athletes and amateur athletes need more medical attention. The fact is that amateurs (athletes), imitating and adopting the methods of physical activity of professional sports, very quickly acquire "sores", to which a professional athlete has been going for many years.

At the same time, in sports, recovery processes have been skewed towards the increasing use of pharmacological agents.

In the process of using physiotherapy, a combination of 3-4 procedures is possible without contraindications and side effects, which increases their potential as restorative agents.

I. Fundamentals of Sports Physiotherapy

The specifics of physiotherapy in sports practice

The trainer and doctor should take into account the following points in their work.

For recovery purposes, physical factors in athletes can be applied both with the same and different frequency. For example, in microcycles with intense loads, procedures can be prescribed every other day, and then two days in a row (before the day of rest and on the day of rest). With minor physical exertion (at the beginning of the preparatory period, after the competition - during recovery), procedures are prescribed at regular intervals. Most often, the number of physiotherapeutic procedures and the intervals between them are set taking into account the entire range of recovery measures for the athlete. In this case, it also matters how quickly it is necessary to restore body functions.

As a rule, in sports, a combination of local and general procedures is used, as well as the use of the same factor for segmental-reflex and local methods of exposure.

At the beginning of the training cycle, methods of general exposure, as a rule, should be prescribed before local ones, since they, having a general strengthening effect of a wide range (baths, showers, general ultraviolet irradiation, aeroionization, etc.), prepare the athlete's body for large physical and psycho-emotional loads.

Throughout the training cycle in preparation for the competition, all rehabilitation measures with the participation of physiotherapeutic methods must correspond to the periods (retractive, basic, special, pre-competition) preparation and be planned individually. The volume of procedures, the number of courses, their frequency and the rhythm of the implementation of rehabilitation measures should be proportional to the loads in terms of the total volume of training.

The training process imposes certain requirements on the methods of physiotherapy. So, with two training sessions a day, after a morning training session, it is better to use procedures mainly of local action (local massage, compresses, chamber barotherapy, etc.), after an evening training - general procedures (baths, general massage, sauna, general magnetotherapy and etc.). General exposure procedures require more time for the deployment of the response and the manifestation of their effect. At the same time, the means of local influence change more often than the means of general influence.

Competition:

- with a one-day variant of its implementation, the use of shortened in terms of time recovery procedures of general action is shown;

- for multi-day ones - it is possible to combine physical methods of influence, but also in a shortened version;

- the tournament version of the competition removes all restrictions.

Treatment of injuries, diseases during the competition with the involvement of physical methods is carried out in a planned manner.

The use of physical factors with restorative, rehabilitation goals depends on the type of sport (predominant development of endurance, strength, speed, etc.), the degree of physical and emotional stress, age, gender of the athlete. The impact should be directed to the accelerated recovery of those systems that are experiencing the main load.

The most effective complex of restorative means in the practice of sports should include a combination of physical factors of influence, pharmacological agents, hygienic means, psychological methods and techniques, pedagogical methods.

Careful monitoring of the body's reactions to the procedures used is required.

Most often, the negative influence of physical factors is due to their inadequate choice, excessive course intensity, underestimation of the athlete's functional state, irrational combination of therapeutic physical factors, and the use of unworked physiotherapeutic techniques.

We must not forget about the effectiveness of the implementation of physiotherapy.

Not all athletes respond the same way to a course or every procedure. Below is table 1, reflecting the dynamics of possible outcomes of the use of physiotherapy techniques.

Table 1

Implementation of the physiotherapeutic effect

Note. The therapeutic effects of physical factors depend on the degree of the initial state of functions - the lower the initial level of the function, the more pronounced healing effect factor a. It should be borne in mind that treatment started at the peak of deterioration is more effective, since it will inevitably be followed by a period of stabilization.

Unlike patients in athletes, the rehabilitation complex includes a larger number of methods, which increases the likelihood of polypharmacy and requires more careful monitoring of the body's response to the procedures used.

In sports medicine, it is important not only to ensure the correct selection and placement of physiotherapeutic procedures, but also to monitor the response of the athlete's body. The effect of physical treatment methods should be assessed by comparing the initial data with the results obtained in the middle and at the end of the training period or collection, as well as with sudden changes in the training process. The monitoring of young athletes, as well as athletes who resume training after suffering injuries and illnesses, should be especially careful. It is important to consider that many physical methods of treatment (radon, sulfide and carbon dioxide baths, sauna, etc.) exert significant stress on the cardiorespiratory and thermoregulatory systems of the athlete's body.

The restoration of sports performance by therapeutic physical factors should be carried out only as directed and under the systematic supervision of a physiotherapist who has experience working with athletes. When prescribing physical factors for the purpose of recovery or enhancement physical performance The physiotherapist should seek the advice of the coach and the team doctor.

In sports medicine, the timing of the resumption of training depends on the nature of the disease or injury suffered and, accordingly, will be different, which will affect not only the choice of physical methods of treatment, but also their combination and arrangement.

If a wide range is used, then the number of procedures per course is no more than 2-4, and the duration of the course is only 5-7 days.

Physiotherapy safety

Medicinal, restorative physical factors should be used with proven effectiveness.

The choice of tactics for the use of physical factors in sports medicine requires not only planning the expected effectiveness, but also assessing their safety, and then comparing the potential benefit with the possible risk.

The risk of prescribing physical factors is characterized by two factors:

- the likelihood of side effects and exacerbations;

- the severity of side effects.

Identification and prevention of side effects helps to prevent medical errors in the practice of sports.

Potential for side effects

To assess the likelihood of side effects when using physical factors for recovery and treatment, you need to know well the effects of the procedure, take into account the individual characteristics of the athlete and, on this basis, present possible side effects.

First of all, we are talking about the mechanism of this or that influence. Side effect some are so closely related to the mechanism of their action that in fact refers to the expected consequences of their use. Neither the doctor, nor the coach, nor the athlete should be surprised by the side effects. Physical factors affect metabolism - this is a natural and inevitable result of their influence.

If the therapeutic and toxic dosages have a small gap, then when the procedure is prescribed, there is always a high probability of side effects. In this situation, special attention should be paid to the systematic assessment of action and early detection of negative consequences. In many cases, it is useful to additionally conduct biochemical or other control for subsequent dosage adjustment. Athletes should be specifically warned about signs of distress.

Children and elderly (veterans) athletes are more sensitive to physical factors: they have a limited or impaired ability to detoxify. In older people, sensitivity to exposure is often increased; in these cases, it is better to use low dosages and minimal courses. In old age, toxic effects may occur due to deterioration of renal function, even in the absence of obvious renal pathology. With significant renal dysfunction, dosage adjustments of many physical factors are required. Kidney or liver disease often increases sensitivity to physiotherapy. In case of impaired liver function, it is dangerous to prescribe physical procedures that change the metabolism so that the excretion of its final products occurs with its direct participation.

In connection with the development of adaptive sports, the veteran direction in various sports, this topic becomes relevant. Some endurance athletes are no exception, especially at the end of their careers.

The ability of the liver to utilize or eliminate metabolites can significantly change under the influence of physical activity of different volume and intensity. The metabolic potential of the liver decreases, and the body becomes sensitive to physical factors under the influence of alcohol.

Able to change the effect of physical factors, pharmacological drugs that affect the blood flow of the liver, kidneys, changing their activity. And this must be taken into account.

In some cases, the combined use of physical factors can lead to:

- to enhance their tonic or stimulating effect on the body, such as the combination of the effects of electrophoresis with diathermy;

- to the occurrence of the opposite effect, as, for example, when using ultraviolet irradiation and irradiation with red light (the skin reaction in the form of solar erythema is leveled);

- to a state when exposure to one factor serves for the subsequent (in a therapeutic dose) a moment that predisposes to skin damage, for example, with ultraviolet irradiation and X-ray irradiation. In the latter case, they talk about the incompatibility of procedures.

At correct execution and dosing of the procedure, it is imperative to observe the body's response to the effect. Different factors can give the same reactions (change in pulse, respiration, etc.), but at the same time, the action of each factor reveals its own specificity.

There is also an individual intolerance to some physical influences.

When prescribing and carrying out physiotherapy procedures, the general condition, physical condition of the athlete and his diseases are taken into account. Contraindications can often arise when concomitant diseases are taken into account. When treating with physical factors, the phenomena of the so-called exacerbation of pathological processes and deterioration of the general and functional state are possible. In some cases, these phenomena are associated with protective reactions, in others - with the phenomena of overdose or an incorrectly performed procedure. In case of even a slight deterioration in the functional state, the athlete or coach must promptly notify the doctor. This also applies to cases of intolerance to procedures.

If the doctor does not recognize in advance the likelihood of side effects, he may be late with their timely identification, correction of dosages and courses. When assigning physical factors, it is necessary to clearly regulate their number, despite their relative safety.

The severity of side effects

The severity of side effects can be described by several parameters, namely:

- the likelihood of a sharp deterioration in health;

- difficulty in identifying and eliminating;

- the time of occurrence.

The concept of the severity of side effects is closely related to the type of possible disorders, especially against the background of high physical exertion in extreme conditions, although it occurs extremely rarely, it deserves a lot of attention, since it can lead to significant negative consequences.

To a certain extent, the severity of side effects depends on how difficult it is to detect and eliminate them. Physical factors that can cause depression are especially dangerous because depression in its initial stages may go unrecognized. To exclude cases of negative consequences, the doctor should warn the athlete about possible symptoms and be wary in this regard.

The reversibility of side effects is determined by the ability to weaken their severity by timely correction of prescriptions. But if there is no constant monitoring during the correction, complications may arise.

The severity of side effects is a relative concept, since it is determined by the conditions in which these side effects appear. For example, the immediate risk of induced arrhythmia in an athlete whose cardiac activity is being monitored is less severe than the risk of arrhythmia without it.

Knowing when a side effect may occur allows the doctor to take steps to lessen the severity and mitigate the effects. That is why it is necessary to instruct the athlete in detail when expecting side effects or revealing low efficiency.

Some physical factors have the so-called effect of the first sessions, that is, the side effect is especially pronounced during the first procedures performed. To avoid a significant number of consequences, it is necessary to recommend the athlete the correct behavior after the procedure.

Taking into account the time factor is important for weakening the severity of another type of side effects - the effect of withdrawal. The cancellation effect can cause rebound syndrome. That is, when the impact is canceled, the “clinic” grows again, perhaps with greater force.

An inattentive attitude to the severity of potential side effects can become the source of many medical errors in the medical accompaniment of an athlete. Assessing the likelihood and severity of possible side effects can greatly reduce the predictable risk associated with them.

Compatibility

There are no absolutely incompatible procedures in physiotherapy. Varying methodological techniques (sequence, intensity, duration, localization), it is possible to reasonably and purposefully use any two, even opposite in action, physical factors.

It is inappropriate to combine procedures in one day that cause a generalized reaction of the body, affecting the general reactivity, which can cause overwork and irritation (two baths; large mud application and a bath; Charcot's shower or Scottish shower and bath; galvanization according to Vermel or Scherbak and mineral or gas bath, etc.).

In one day, two procedures for the same reflexogenic zone (collar area, nasal mucosa, etc.) are incompatible, through which an active effect on the general reactivity of the body is carried out.

It is inappropriate to combine physical factors on one day that are close in their physical nature (sunbathing and UV irradiation, mud therapy and naphthalan therapy, two high-frequency electro procedures, etc.).

Multidirectional procedures (mud, paraffin applications, inductothermy and cold bathing, showers) are not carried out (with the exception of special tasks) on the same day, as this can excessively enhance the body's response, cause an exacerbation of the pathological process.

You should not prescribe on the same day procedures that stimulate and depress the functions of the central nervous system and the main nervous processes (electrophoresis of bromine and Charcot's douches, Scottish shower; wet wraps and cold baths; electrophoresis and caffeine electrophoresis; pine baths and Charcot's showers, etc.). The exceptions are cases when, for the purpose of training, it is necessary to simultaneously influence the processes of excitation and inhibition in the nervous system.

Compatibility is the sequential use of two procedures, opposite in their effect (heat and cold, exciting and soothing, etc.) only for:

a) weakening or termination of the previous procedure (after baths or mud applications - a cool shower; after UV irradiation - infrared rays);

b) obtaining a contrast reaction in order to provide a training action (hot and cold showers, local hot and cold baths).

Two procedures that cause severe skin irritation (ultraviolet erythema therapy and massage) are not prescribed in one day.

Electrosleep is incompatible on the same day with other general electrotherapy procedures (galvanization and medicinal electrophoresis according to Vermel or Shcherbak, general darsonvalization, nasal electrophoresis, etc.).

You should not combine several even small procedures in one day if it is impossible to provide the required time interval between them.

It is not recommended to prescribe two electrotherapy procedures in one day. An exception is medicinal electrophoresis, which, in order to increase the amount of the injected substance and the depth of its penetration, can be carried out on the same day with the UHF procedure, inductothermy, microwaves, etc. Diadynamic therapy and amplipulse therapy can be combined with some types of electrotherapy in one day.

On days of rather heavy and / or prolonged exhausting physical exertion, it is advisable to refrain from physiotherapy procedures. The same applies to the days of difficult and tiring diagnostic studies (fluoroscopy, duodenal intubation, determination of the basal metabolic rate, etc.).

Ultraviolet erythemal irradiation is incompatible with thermal procedures, massage, galvanization, inductothermy and microwave therapy in the same zone, area. Outside the location of the erythema on the same day with UV irradiation, any physical factors can be applied.

Erythema therapy is incompatible with radiotherapy for the same area. After ultraviolet erythema, X-ray therapy can be performed in 5-7 days. After a course of radiation therapy, erythema therapy is possible in a month.

Mud therapy is incompatible on the same day with general baths, other types of thermal therapy, general darsonvalization.

When combining hydrotherapy and phototherapy, general irradiation should be carried out first, and then hydrotherapy. Local irradiation is prescribed after water procedures. Other local treatments usually precede general treatments.

In one day with many procedures, including general ones, you can combine local methods of galvanization and drug electrophoresis; diadynamo and amplipulse therapy; UHF, microwaves, ultrasound; darsonvalization; oxygen therapy, aeroionization, aerosol therapy, internal intake of mineral water.

Physiotherapy procedures that are incompatible on the same day, if indicated, may be prescribed on different days. See also the compatibility table in the appendix.

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The most important theoretical and methodological position of the concepts of modern sports is in the unity of training, competition and recovery... Recently, more and more specialists in the field of sports medicine and physiotherapy are turning to the use of physical means to restore and improve the physical performance of athletes. Currently, a number of methods have been developed for the influence of electro- and hydrobalneoprocedures on the course of adaptation and recovery processes in the athlete's body, which are successfully used both at different stages of the preparatory period of the training cycle and during competitions. Manifold physical characteristics and a wide range of these procedures, different options localization, determine the appropriateness of their use not only as a means of restoring or increasing performance, but in some cases and as a way to increase the body's protective-adaptive reactions and prevent the occurrence of pre-pathological and pathological conditions in athletes.

The use of physical factors in sports medicine is based on a number of reasons:

sports loads increase to prohibitive ones, often athletes train on the verge of pre-pathological and pathological conditions, often situations of acute and chronic overstrain of various organs and systems. This leads to the search for new methods and techniques of recovery in sports, which is especially important in children and youth sports and in high-performance sports;
the use of physical factors significantly increases the speed and efficiency of recovery, improves the physical condition of athletes, is the prevention of overwork and overstrain;
physiotherapeutic factors are not doping: they do not have a negative effect on the athlete's body, are not legally prohibited and are not detected during doping tests,
physiotherapeutic factors are natural for humans, due to which they are generally well tolerated, in healthy athletes they usually have no contraindications,
when using physiotherapeutic factors, the drug load on the body, on the gastrointestinal tract does not increase, and the body's allergization does not increase;
with the correct use of physical methods, it is possible to selectively influence various organs and systems, functions, and various links of recovery; at the same time, it is possible to simultaneously influence many functional systems of the body; the influence of physical factors can be specific or universal;
there are empirically substantiated positive effects and schemes for the use of physical methods in athletes, the evidence base for the positive influence of physiotherapy is being formed.

The place of physiotherapeutic methods in the recovery system of athletes is clearly defined scientifically, organizationally and methodically. In sports, physiotherapy is used:

in rehabilitation after injuries and illnesses;
in the system of restoring sports performance after intense training and competitions.

According to the classification of Graevskaya et al., 1971, the system of restoration of sports performance is a complex application of three groups of means: pedagogical, which are the prerogative of the coach, psychological and medical. To medical, among others, include physiotherapeutic agents. Their use is regulated by the Order of the Ministry of Health and Social Development N 613n dated 08/09/2010 "On approval of the procedure for the provision of medical care during physical training and sporting events". In particular, the Order also establishes the procedure for the provision of medical assistance during rehabilitation measures after intense physical exertion in sports, after past diseases and injuries in athletes. According to the Order, the purpose of recovery measures after intense physical exertion is to maintain and improve the functional state and sports uniform an athlete at any given time interval. A team of specialists has been identified who make up a program of rehabilitation measures after intense physical exertion, which also includes a physiotherapist. Rehabilitation measures are possible at the medical center of the sports facility, in the medical and physical dispensary, center physiotherapy exercises and sports medicine, in the rehabilitation department of a medical organization. For the organization of physiotherapeutic assistance in a medical and physical dispensary, 1 position of a physiotherapist for 5 positions of doctors in sports medicine, a position of nurses in physiotherapy and the organization of a physiotherapy department are provided.

The list of factors used is wide and different from one author to another. The main physical factors in the system of post-exercise recovery of athletes:

massage;
hydro-procedures - underwater shower-massage, Scottish shower, bath-sauna: baths: contrast, vibration, pearl, sodium chloride, coniferous, carbonic, iodine-bromine, turpentine, etc .;
electrolight procedures - electrostimulation, amplipulse therapy, local pressure chamber, baromassage, electrosleep, magnetotherapy, galvanization, aeroionization, electroacupuncture, laser therapy, decimetwave therapy, laser therapy, light therapy, hypoxicators;

the level of the athlete's functional readiness;
the tasks facing the athlete;
the degree of loading of individual physiological systems;
orientation of the training process and annual cyclicity of loads;
the whole range of rehabilitation measures that an athlete receives; and etc.

In the literature, the principles of choosing the means of recovery and ready-made complexes of physiotherapeutic procedures are given.

According to G.R. Gigineishvilli, all means of restoring sports performance in physiotherapy are conventionally divided into three groups:

Means that have a general effect on the body- general physiotherapy procedures: baths, showers, electrosleep, electrical procedures carried out according to reflex-segmental techniques. These procedures are the basis of restorative measures, are prescribed when fatigue is widespread, captures a number of physiological systems of the body, accompanied by a deterioration in the course of adaptive reactions. The effect of their application has a cumulative nature, is realized later, therefore it is advisable to conduct a course of procedures, which, depending on the tasks at hand, may be quite complete or shortened.
Local influences. Usually these are electrical procedures performed on the area of muscles that are tired after physical exertion. For this purpose, sinusoidal modulated currents (SMT) and an ultrahigh-frequency electromagnetic field (UHF EMF) - decimetwave therapy (UHF-therapy) are often used.

The procedures have mainly a selective effect on the neuromuscular apparatus, relieve the feeling of fatigue, muscle "clogging", pain, help to urgently restore anaerobic processes in the muscles, improve blood circulation. The procedures are prescribed after the performance of training loads of a speed-strength orientation or any other loads leading to the occurrence of local muscle fatigue, preferably immediately after the end of work in the intervals between training loads. The concept of "local procedure" is rather arbitrary, since the procedures indirectly affect the cardiovascular and nervous systems.

3... Effects on biologically active areas.

For example, the effects of exposure to various physical factors on the adrenal gland and thyroid gland are described - physical performance is growing more actively, the standing of the immune system is stabilized, and a pronounced immunostimulating effect is manifested. However, any invasion of the immune and endocrine systems is fraught with serious consequences and complications in the form of failures in the work of these systems and subtle mechanisms of neuro-humoral regulation and is dangerous.

The principles of using physical factors in the recovery system of athletes differ significantly from the principles of private physiotherapy in the clinic and are formulated by G.R. Gigineishvilli:

The principle of an individual approach.
They are especially indicated in the preparation of highly qualified athletes during periods of intense training or competitive activity, as well as after "shock" microcycles, when it is necessary to restore the functional state of the body as much as possible and compensate for violations.
Long-term use of some electrotherapeutic or balneotherapy procedures is not recommended, since the body adapts to them, which leads to a decrease in efficiency. Long-term use of physical factors can impair natural recovery ability.
Methodological approaches to the use of FT in athletes and in clinical practice are different.

In the practice of training athletes with a recovery purpose, they can be used both with the same and with different periods of time.

For example, during the period of intensification of training loads, when on certain days of the microcycle complete restoration of body functions is undesirable, physiotherapeutic procedures can be prescribed in the middle of the microcycle, and then two days in a row; before the day of rest and on the day of rest.

At regular intervals, procedures are more often prescribed at the beginning of the preparatory, in the pre-competition and post-competition periods, when carrying out recovery measures in athletes who have an inadequate response to training loads or have signs of severe fatigue.

The duration of the use of a physical factor is 10-20 days, during which a course of rehabilitation therapy is carried out, consisting of 6-10 procedures.

The number of FT procedures and the intervals between them are set taking into account the entire range of rehabilitation measures. If a wide range is used, the number of procedures is reduced to 2-5 per course, the duration of the course of exposure to a physical factor can be only 5-7 days. The number and frequency of taking procedures also depend on the degree of fatigue of the athlete and on how quickly it is necessary to restore body functions.

5. Taking into account the level of fatigue of the athlete. With the development of severe fatigue and with the appearance of the first signs of overwork and physical overstrain, physical factors are chosen that have a milder effect on the body, reduce the dose of exposure (current value during electrical procedures, concentration of mineral, gas and aromatic baths, temperature difference during contrast baths), duration of the procedure , alternation frequency. In the presence of severe fatigue or fatigue, preference is given to procedures of local influence, or physical factors are first applied according to local methods, and then, as the athlete's functional state improves, they switch to procedures that have a general effect on the body.
6. Combination of procedures.

general and local procedures are well combined.
a good effect - when using the same factor at the same time according to segmental-reflex and local methods of exposure (for example, SMT or microwave EMF).
hydrotherapy procedures and general thermal therapy (sauna) can be prescribed in combination with partial manual or vibration massage, impulse currents and microwave therapy for muscles. Sometimes the second, local, procedure is prescribed immediately, sometimes - a few hours or 1-2 days after the general exposure.
the possibility of combining two general procedures is not excluded, which in this case are arranged in time with a break of up to 1-3 days and try to choose so as to obtain a multidirectional effect or one procedure complements the other (in clinical practice, 2 general procedures are usually not combined).

Prescribe a procedure that has a tonic effect on the body before training and a procedure that has a sedative effect after training or in the evening. In this case, the second, the procedure is usually carried out the next day after the first or later.

In general, it is believed that only one procedure with a general effect on the body is advisable on one day, although exceptions are possible (for example, a general effect in the form of a sauna and a general manual massage or an underwater shower-massage are combined on one day).

7. Mandatory medical supervision. The complex of restorative physiotherapy is prescribed by a doctor, who subsequently controls the adequacy of the impact to the state of adaptation processes in the athlete's body.

Table 1

Differentiated use of physical factors to restore the performance of athletes:

A link in the overall functional system in need of optimization of recovery processes	Physiotherapy procedures
Cardiorespiratory system (aerobic energy supply mechanisms)	Water and dry carbon dioxide baths Baths of "white" turpentine emulsion and mixed turpentine Iodine-bromine baths CMT for the cervicothoracic region
Neuromuscular apparatus (anaerobic mechanisms of energy supply)	CMT for the most loaded muscle groups Microwave EMF on the most loaded muscle groups Sodium chloride baths Baths of "yellow solution" turpentine and mixed turpentine
CNS (psycho-emotional state)	Sedative effect: ES with a pulse frequency of 10-20 Hz Iodine-bromine baths Coniferous baths Toning effect: ES with a pulse frequency of 90-100 Hz Sodium chloride baths Baths of "white" turpentine emulsion
The immune system	Microwave EMF on the projection area of the thyroid gland Microwave EMF on the projection area of the adrenal glands Microwave EMF on the collar area CMT on the cervicothoracic region paravertebrally General ultraviolet irradiation

Note: CNS - central nervous system, SMT - sinusoidal modulated currents, UHF EMF - ultrahigh frequency electromagnetic field, ES - electrosleep

Approximate complexes of the main physical and physiotherapeutic means of recovery have been developed by the Research Institute of Balneology and Physiotherapy:

Manual massage, UHF therapy, warm shower;
Sauna, manual massage, amplipulse therapy;
Sauna, swimming pool, electrophoresis;
Galvanized vibrations, segmental massage, acupuncture;
Contrast shower, baromassage, galvanization;
Amplipulse therapy, circular shower, local manual massage;
Foot baths, vibration massage, rain shower, magnetic therapy;
Underwater jet massage, rain shower, magnetic therapy;
General massage, sauna, electroacupuncture;
Contrast bath, local massage, diadynamic therapy;
Inductothermy, segmental massage, methods of suggestion;
Baromassage, hygienic shower, ultraviolet irradiation;
Swimming in the pool;
Electrical stimulation, acupuncture, manual massage;
Warm shower, galvanization, segmental massage;
Electrical stimulation, baromassage of the lower extremities, warm shower;
Sollux, electrosleep, swimming pool;
Local manual massage, vibration massage, warm hand shower;
Warm shower, pool, suggestion techniques,
Contrast shower, baromassage, electrophoresis.

V last years in the complexes they actively use magnetotherapy, cryotherapy, aeroionotherapy, chromotherapy.

The use of the complexes differs taking into account the direction of the training loads. Table 2 shows the complexes of rehabilitation procedures, taking into account the direction of the loads of the previous and subsequent classes.

G.R. Gigeineshvili offers his complexes that have shown good clinical efficacy:

1. chloride sodium baths (or contrast, "white" turpentine, carbonic) before training and electrosleep according to the sedative technique in the evening or before going to bed;

2. electrosleep with a pulse frequency of 90-100 Hz before training and iodine-bromine (or pine, nitrogen) baths after it.

Such actively operating complexes of procedures are carried out in the most crucial periods of preparation or in the case when it is necessary to achieve a quick restoration of the most important functions of the body.

table 2

The use of rehabilitation procedures, taking into account the direction of the loads of the previous and subsequent sessions

The focus of the second lesson

The focus of the first lesson	Rehabilitation means
Speed-power	A. Massage. Irradiation with visible rays of the blue spectrum. Warm eucalyptus bath. B. Warm bath (eucalyptus, aromatic, nitrogen, coniferous, iodine-bromine). SUF irradiation, chromotherapy, general low-frequency magnetotherapy, general cryotherapy	Aerobic
Aerobic	A. Oxygen bath. Toning rubbing. Air ionization. B. Alpha massage, aeroionotherapy, aerofitotherapy Oxygen pearl bath.	Anaerobic
Anaerobic	A. Hyperbaric oxygenation. Carbonic bath. Hydromassage. B. Normobaric hypoxic therapy. Souls. Hydromassage, Carbonic bath (gas or dry)	Aerobic

The focus of the first lesson

Rehabilitation means

Speed-power

A. Massage. Irradiation with visible rays of the blue spectrum. Warm eucalyptus bath.

B. Warm bath (eucalyptus, aromatic, nitrogen, coniferous, iodine-bromine).

SUF irradiation, chromotherapy, general low-frequency magnetotherapy, general cryotherapy

Aerobic

A. Oxygen bath. Toning rubbing. Air ionization.

B. Alpha massage, aeroionotherapy, aerofitotherapy

Oxygen pearl bath.

Anaerobic

A. Hyperbaric oxygenation. Carbonic bath. Hydromassage.

B. Normobaric hypoxic therapy. Souls. Hydromassage, Carbonic bath (gas or dry)

Aerobic

Note: A - V.N. Platonov, 1997; B - Yu.M. Shkrebty, 2005; UV irradiation - medium-wave ultraviolet irradiation

Physical factors and physiotherapeutic procedures are actively used for the prevention of fatigue, correction of fatigue and for the treatment of maladaptosis that has arisen.

To prevent fatigue, physical factors are used for prophylactic purposes in sports associated with a long duration of competitions and repeated performances (weightlifting, gymnastics, fencing, martial arts, all-around, etc.). In this case, physical methods are divided into groups:

Methods of general stimulating action;
Methods for modulating the psychoemotional state;
Antihypoxic and haemo-stimulating methods.

G.N. Ponomarenko et al. As a step-by-step long-term prevention of fatigue, it is recommended to use the following factors that provide a complex general stimulating and modulating effect:

hemomagnetotherapy and general magnetotherapy. The method acts through the influence on the autonomic nervous system and, in particular, its higher parts - the hypothalamic-pituitary system, the reticular formation. As a result, there is a synchronization of the bioelectrical activity of the brain, a change in conditioned reflex activity, an improvement in cerebral circulation, an improvement in psychomotor qualities.
thermomagnetotherapy;
laser blood irradiation;
general air cryotherapy;
aeroionotherapy;
extreme high frequency therapy;
24-hour aerotherapy
oxygen therapy - in the form of oxygen inhalation at atmospheric pressure;
hypoxytherapy - normobaric interval and periodic hypoxytherapy (inhalation of a mixture with a reduced oxygen content in short intervals of 5 minutes alternating with inhalation of air and, accordingly, long - up to 60 minutes continuously - inhalation of an air mixture with 10% oxygen), dosed hypobaric hypoxia using a pressure chamber ...
hyperbaric oxygen therapy;
oxygen baths.

In the correction of overwork, physical factors come to the fore, having a predominant effect on the function of the central nervous system and the psychoemotional state, since the overstrain of the central nervous system is essentially the first phase of sports illness.

To restore the function of the central nervous system and restore the functional state of the athlete, use:

primarily various hydrotherapeutic factors): dry-air bath (sauna), contrast baths, showers - Charcot, Scottish, circular, Vichy, underwater shower-massage;
selective chromotherapy,
vibration massage relaxation, - alpha massage (alpha capsule);
audiovisual relaxation;
general magnetotherapy combined with music therapy;
electrosleep therapy;

An important role is played by physiotherapeutic procedures in the treatment of frolicking maladaptosis. The most common maladaptosis in sports is chronic fatigue syndrome, manifested by a pronounced feeling of fatigue that does not go away after sleep, leading to a decrease in physical and mental performance, manifested by vivid symptoms of asthenia. Table 3 the physical methods used for the correction of asthenic syndrome are systematized.

Table 3

Physical therapies for patients with chronic fatigue syndrome

Methods	Procedures
Actoprotective	General air cryotherapy, electrosleep, medium and high pressure showers, wet wrap
Sedatives	Electrosleep therapy, general low-frequency magnetotherapy, galvanization of the brain and segmental zones, medicinal electrophoresis of sedatives, tranquilizers and antidepressants, local darsonvalization of the head and collar zone, iodine-bromine, pine and nitrogen baths, aerophytotherapy of sedatives, round-the-clock aerial therapy.
Psycho-relaxing	Selective chromotherapy, vibromassage relaxation, audiovisual and volumetric-acoustic relaxation, alpha massage, medicinal lithium electrophoresis
Tonic	Therapeutic massage, contrast baths, thalassotearpy, medium pressure showers, aerophytotherapy of tonic preparations, general ultraviolet irradiation (medium and long wave)
Vegeto-correcting	Electrosleep therapy, transcranial electroanalgesia, galvanization of the brain and ganglia of the sympathetic trunk, low-frequency magnetotherapy, (head, cervical sympathetic nodes, heart), UHF - therapy, (carotid sinus zone, solar plexus, cervical sympathetic nodes, transcerebral), infrared laser therapy, baths, showers of medium and high pressure, climatotherapy
Immunostimulating	Heliotherapy, laser blood irradiation, inhalation therapy of immunomodulators, drug electrophoresis of immunomodulators, high-frequency magnetic therapy of the thymus.

In addition, when using physical factors, the training period (annual training cycle) must be taken into account.

A. During the preparatory period:

at the beginning of the preparatory period, general procedures are prescribed that contribute to the effective restoration of the function of the cardiovascular system;
during the period of increasing the volume and intensity of loads, sodium chloride and turpentine baths are shown - they have a positive effect on the state of vegetative functions, on the state of the musculoskeletal system, increase efficiency;
by the middle and the end of the preparatory period, more attention is paid to the development of special qualities, techniques, speed-strength qualities, therefore, methods are often used to help relieve fatigue in the most loaded organs and systems.

B. In the pre-competition and competition period.

an athlete is at the peak of his athletic form, but high demands are placed on his psycho-emotional state, the immune system... General strengthening procedures are prescribed, especially electrosleep with a frequency of 10-20 Hz, iodine-bromine baths are shown. The procedures have a positive effect on the cardiovascular and nervous system, but do not give a relaxing effect.
it is possible to prescribe procedures that have a positive effect on the metabolism of the heart muscle (amplipulse or decimetre wave radiation on the collar zone).
sinusoidal modulated currents to the most loaded muscles before striations - the procedure increases mobilization readiness by activating the neuromuscular apparatus, increasing the initial level of vegetative and metabolic processes. The procedure is indicated for athletes of cyclic sports and is not indicated where a fine muscle feeling is needed, which can be reduced due to the analgesic effect of the procedure.
during the competition period, new, previously untested procedures are not applied.

Physiotherapy procedures are also used to adapt athletes to new conditions during transmeridial flights.

Thus, the range of application of physiotherapeutic factors and techniques in the system of restoring physical performance and improving the physical condition of an athlete's body is wide and varied. Competent application is possible only with a deep knowledge of the mechanisms of action of physical factors, taking into account all the features of the training process and requires knowledge and joint work of a physiotherapist, a sports medicine doctor and a trainer.

First published: Topical issues of diagnosis, treatment and prevention in the system of medical rehabilitation and sports medicine: a collection of works of the regional scientific and practical conference... - Chelyabinsk: ChelGMA, 2013 .-- 89 p. S. 73-84

Uskov G.V., Voznitskaya O.E.,
GUZ "Chelyabinsk Regional Medical and Physical Training Dispensary",
FGOU HPE "Ural State University of Physical Culture"

Physiotherapy methods are proposed for practical use as a means of correcting factors limiting athletic performance, recovery during training sports qualities... Physiotherapy can reduce pharmacological stress.

Physiotherapy, having a wide range of therapeutic and prophylactic effects, having a homeostatic nature of action, good compatibility with other therapeutic agents, availability, cost-effectiveness, can and should be widely introduced into the medical practice of sports, used by professionals and amateurs of sports as effective, timely, individual, methodically accurate remedy.

For sports medicine doctors, teachers of medicine and sports, coaches, athletes.

table 2

Means of sports injury rehabilitation by periods

Galvanization, electrophoresis, phonophoresis of vasodilators, infrared irradiation, LF magnetotherapy, warming compress, fresh baths (local), water heating pad, red laser therapy, ultratonotherapy.

Fibromodulating methods

Ultrasound therapy, electrophoresis of defibrosing drugs, peloid therapy.

Myostimulating methods

Diadynamic therapy, amplipulse therapy, interference therapy, percutaneous electro-neurostimulation, hydromassage (underwater shower massage).

Basic principles of trauma management

1. The presence of pain syndrome requires its relief during the first 2-3 procedures, since anti-inflammatory therapy is less effective until the pain sensations disappear, just as intact edema prevents heat exposure.

2. Depending on the area of influence, mainly specific or non-specific effects caused by a specific factor are realized.

The likelihood of specific effects is higher with local and segmental, nonspecific - with generalized exposure to physical factors.

In the process of rehabilitation, the doctor, coach and athlete have the following tasks:

1) relief of post-traumatic stress;

2)? Preservation during treatment is sufficient high level development of the neuromuscular apparatus of the damaged area;

3)? Early recovery of the range of motion and strength of the damaged area;

4)? The creation of a certain psychological background in the athlete, helping him to quickly move to full training;

5) - maintenance of general and special fitness.

On the solution of these problems, the whole complex of measures with a therapeutic and training orientation is based, including various types of special physical and psycho-emotional exercises, physiotherapy techniques, which are quite well developed (according to the type, localization and complexity) for all its periods.

The following forms of exercise are used:

- morning exercises;

– physiotherapy, aimed at the rehabilitation of the lost function;

- special training sessions.

Morning exercises includes a complex of physical exercises of a general developmental nature, which is habitual for an athlete, from which only exercises with a load on the injured area (zone) are excluded. Duration morning exercises- 10-15 minutes.

Physiotherapy depends on the nature of clinical manifestations and the stage of trauma treatment and can be used during the period of immobilization, post-immobilization period, the period of full functional rehabilitation.

Immobilization period. A fixing bandage was applied and active movements are impossible, which negatively affects the functional state of the neuromotor apparatus of the damaged organ.

In the acute period, the duration of which depends on the nature of the injury and is 2–5 days (pain syndrome is expressed), active movements are used in the joints free from immobilization and ideomotor training, when the athlete mentally tenses the muscles and makes movements in the joints, and also mentally imagines some movements of a training and competitive nature.

Before starting ideomotor training, the athlete must take a comfortable position (lying or sitting), close his eyes, relax as much as possible and take several calm deep breaths and exhalations. Then the athlete, using auto-training, reduces the feeling of pain in the area of the injury. This is because during trauma, a person's consciousness is involuntarily fixed on pain sensations, causing reflex muscle tension, which, in turn, further intensifies the sensation of pain. To reduce the feeling of pain, it is important for the athlete to shift their attention to other sensations and objects. For this, the following verbal formula can be proposed: “The pain in my leg (arm) begins to gradually disappear, I still feel some tension, but muscle stiffness and the accompanying unpleasant emotions have already left me. The leg (arm) can perform all the movements necessary for the forthcoming exercise, and the pain and stiffness have completely disappeared. " After it, you can go directly to ideomotor training.

Athletes have a high accuracy of musculo-motor perception, therefore, if they have not been engaged in ideomotor training before, they quickly learn to mentally strain their muscles and figuratively imagine the performance of movements characteristic of the chosen sport. Ideomotor training sessions are held 2-3 times a day for 10-15 minutes.

In the subacute period (subsiding of pronounced painful phenomena), isometric exercises are added to the described exercises - static alternating tension and relaxation of the muscles of the injured area. For example, keeping a straightened strained limb on weight - 10 s of tension and 20 s of relaxation (with repetition). In this case, the effort should increase gradually and reach the maximum value at the 6-7th second. The rest period after each exercise should be sufficient. Isometric exercises make it possible to selectively target different muscle groups. The complex consists of 4-6 exercises performed from different positions - sitting, lying on your back, stomach, on your side. It is advisable to carry out the exercises at least 2-3 times a day for 10-15 minutes.

Isometric exercises allow not only maintaining a sufficiently high muscle tone, but also maintaining an active level of nervous processes.

Postimmobilization period. This is the period after the removal of the plaster, fixing the bandage. The main task is to develop joints (for full range of motion) and restore strength in the injured area.

According to the doctor's prescription in the post-immobilization period, physiotherapeutic methods of treatment are used, including natural and artificial physical factors of various physical properties and therapeutic effects. A special place among them is occupied by warm and hydrotherapy procedures.

Thermal treatments are the effects on the body of therapeutic mud, paraffin, ozokerite, to varying degrees, affecting physical thermoregulation, promoting the expansion of peripheral vessels and redistribution of blood, stimulating respiration, having an anti-inflammatory and resorbing effect, contributing to tissue regeneration.

Hydrotherapy procedures are the effect on the body of fresh water and mineral waters(sometimes artificially prepared). The action of water on the body is based on thermal, mechanical, chemical irritation. Depending on the water temperature, all hydrotherapy procedures are conventionally divided into cold (below 20 °), cool (20-35 °), warm (37-39 °) and hot (40 ° and above).

The development of movements (for example, in an injured joint) begins immediately after carrying out physiotherapy procedures, massage, that is, after muscle relaxation, a decrease in resistance to stretching. All this contributes to a freer, without undue stress, exercise.

This is also facilitated by movement in warm water with simultaneous self-massage, which is carried out in a regular bath or special baths (water temperature - 37–39 °). During massage, the muscles should be relaxed as much as possible, they are pulled by the entire brush of the masseur from the bone bed and are carefully worked out. All movements of the massaging hand go from the foot to the thigh and from the hand to the shoulder - from the bottom up. After the massage, they begin active and passive movements in the water. The duration of the procedure is 15-30 minutes. After that, it is advisable to apply a compress with ointment to the injured area, which will facilitate the further recovery process.

In the first days, all movements are performed in light conditions, that is, they are carried out passively or with the use of special devices.

Before starting classes, it is necessary to determine the indicator of active movements, that is, movements that can be performed independently, and passive movements, that is, movements that a doctor, nurse, exercise therapy instructor helps to perform. Indicators of passive movements usually exceed indicators of active movements. The greater the difference between these indicators, the greater the reserve extensibility, and, consequently, the possibility of increasing the amplitude of active movements.

For example, stretching exercises (active, passive and active-passive) are the main means of restoring the full range of motion in the joints. These include exercises for flexion, extension, as well as abduction and bending, which allow in a complex and selectively affect the musculo-ligamentous apparatus or those parts of it that limit the mobility of the joints. These exercises must be combined with muscle relaxation exercises, such as those aimed at deliberately voluntary muscle relaxation. These include exercises to relax the hands and shoulder girdle- the body is half inclined forward, the arms hang freely; raise the shoulders up and, having relaxed them, lower them, making rocking movements.

Most joint exercises are performed dynamically in rhythmic, flowing movements. The number of these movements in each series is 8-12, since a separate short-term effect on the musculo-ligamentous groups is practically of no benefit. In addition, you can apply elastic or springy fixation at the end of each movement, while simultaneously increasing the amplitude in the series to its maximum.

As the range of motion increases, you can begin exercises with additional weights that enhance the effect of stretching forces.

When developing movements, one should adhere to the principle "less is better, but more often", therefore, each lesson includes no more than 5-6 series of exercises and perform them 10-12 times daily.

The restoration of muscle strength during this period is achieved with the help of strength exercises (preferably on special simulators), with alternating work and rest, in the relationship between the intensity and volume of training loads.

With the help of training devices, you can select an adequate load, accurately dosing the total effort, the effort of a single movement or a series of movements. In addition, training devices allow providing a protective mode of work in injured parts of the musculoskeletal system with a simultaneous significant load on healthy parts.

A relatively large amount of muscle work causes positive changes in metabolism, activates trophic processes, creates conditions for plastic metabolism, which has a beneficial effect on recovery. Simple exercises are used first, followed by light weight exercises performed at a medium pace. The number of repetitions is maximum. At the same time, the athlete can quite accurately assess his condition and his feelings and, if necessary, must stop training in time to avoid overload or re-injury.

With an increase in fitness, the load should be gradually increased due to the number of repetitions, and not due to an increase in the weight of the weights.

The magnitude of the burden, the number of approaches and repetitions in one approach are determined in each case individually, depending on the clinical and anatomical and morphological features of the recovery processes and the individual capabilities of the athlete.

Rest intervals between sets should be longer than usual and allow full recovery from the previous load. Relaxation exercises can be used as active rest during breaks. In this case, muscle relaxation is carried out somewhat differently than when developing joints: more quickly, more fully, and after preliminary tension. Relaxation exercises should be combined with breathing exercises that reflexively promote muscle relaxation.

For example: while sitting or lying down, take a deep breath, hold the breath, then slightly strain the muscles of the whole body, legs, feet, abdomen, arms, shoulders, neck, chewing muscles... The athlete does not breathe for 5-6 seconds and then, making a slow exhalation, relaxes the muscles. The exercise is performed 5–6 times, with each time increasing the degree of relaxation.

Static exercises are also used. Static (isometric) exercises are selected in such a way as to emphasize the effort on the main or critical moments of the competitive movement. The principle of isometric strength training during this period is to actively tension the trained muscle or muscle group and maintain this tension for a certain time. The most effective tension for 6-8 s with repetition of 5-6 times. The following exercises can be used for isometric training:

- tension with an emphasis on stationary objects;

- tension using movable weights, which are lifted to a low height and maintained for a given time;

- tension using a spring or elastic elastic resistance.

The rational alternation of dynamic and static strength exercises allows avoiding sharp painful sensations in the muscles and joints, which often arise when a significant amount of dynamic strength exercises alone is used.

Exercises should gradually become more difficult, the duration of their impact should increase. So, when the strength of the injured limb is restored up to 75–80%, in comparison with the healthy one, it is possible to include in the exercises exercises on special training devices that simulate training equipment.

In a complex of measures to restore strength as additional funds muscle training use electrical muscle stimulation and tonic massage.

The purpose of electrical stimulation is to maintain contractility and stimulate blood circulation in weakened muscles. It is most advisable to use electrical muscle stimulation in the early stages - after removing the fixing bandage, causing a forced contraction of the weakened muscles. The training is carried out once a day with control and correction based on subjective feelings.

A training method for the rehabilitation of athletes with vertebral pain syndrome (VHD) with dorsopathies using electromyographic feedback (EOS) was proposed by O.N. Polyakova (2008). The method includes 3 stages in the general methodological scheme of training: preparatory, basic and supporting.

The duration of the preparatory stage is 3 daily sessions of 30 minutes in order to get acquainted with the EOS method and teach skills to work using the selected muscle group.

The main stage is aimed directly at working with the specified muscle groups, the violation of the state of which led to the formation of the leading pathological link. The achievement of the clinical goal is determined by: reducing pain, up to their termination, overcoming the symptoms of muscle fatigue, expanding the level of loads, increasing the volume and strength of movements in the spine. The author of the method indicates that the achievement of positive results is confirmed by objective data using the registration of electromyographic (EMG) signals during EOS sessions. Depending on the task, it is possible to record the integral EMG during relaxation of the back muscles, the EMG values during their submaximal tension, the asymmetry coefficient during the tension of the paravertebral muscles, antagonist muscles.

The main stage consists of 12-15 30-minute sessions carried out daily according to the scheme (5 + 2).

The final stage is a supporting stage, carried out with the aim of strengthening the acquired motor skill.

Supporting sessions in the amount of 6 are carried out 1-2 times a week, lasting 30 minutes, which allow you to maintain the formed skill that reliably protects the athlete from muscle overstrain and associated pathological manifestations.

The developed method of rehabilitation of athletes with VHD syndrome using EOS allows for targeted training of various groups of back muscles. The timing rehabilitation treatment are reduced by almost a third compared to the period of traditional rehabilitation.

Toning massage (self-massage) in the area of damage it is used as a means of restoring muscle strength. Particular attention is paid to shock techniques that cause reflex contraction of muscle fibers, increase muscle tone, enhance the flow of arterial blood to the massaged area, activating metabolic processes, and increase the excitability of sensory and motor nerves. Percussion techniques usually alternate with shaking.

The massage can be carried out 2-3 times a day, the duration of one session is from 8 to 10 minutes.

Physiotherapy in this period it is used in the form of special training sessions. Special training sessions can be started immediately after the acute pain subsides already in the immobilization period, in the post-immobilization period they take the main place and become more complete.

It is known that a complete cessation of training during an illness negatively affects the level of an athlete's fitness: not only his performance decreases, but also those specific motor skills, which take a lot of time to recover in the future. A means of maintaining general and special fitness is the selection of individual training exercises... It is important to select exercises that, without the risk of re-injury, could compensate for the usual training load and, if possible, would retain the motor stereotype of a special movement.

The motor regime of an athlete in the post-immobilization period largely depends on the location of the injury.

General performance can be maintained by swimming.

Trainings are carried out 4-5 times a week with an average duration of 60 minutes in compliance with the usual structure of a training session: preparatory, main and final parts.

Full functional rehabilitation period. It is difficult to establish the end of the post-immobilization period and the beginning of the next period - full functional rehabilitation, since they are organically interconnected and gradually merge into one another. The approximate border is the complete restoration of muscle strength and range of motion in the damaged area (area), which can be determined by comparison with a healthy limb.

The main task of the period of full functional rehabilitation is 100% recovery after injury.

In this period, along with the previously used exercises, methods and means of special strength training are used, designed to restore strength abilities characteristic of the chosen sport.

Perhaps the most responsible and difficult during the period of complete functional recovery is the moment of transition to full-fledged special training sessions. This is due to the fact that trauma, awareness of the need for treatment and the healing process itself affect the mental state of the athlete, causing fear and uncertainty in their abilities and the ability to develop the previous maximum effort. Trauma memory is not limited to local changes. Trace pathological reactions in the subcortical area of the brain significantly exceed the duration of anatomical and functional recovery in the injured area on the periphery and are the main goal of the therapeutic effect.

To remove a negative psychological background, the following rules must be observed:

1)? Start full-fledged special training sessions only with the complete disappearance of the pain syndrome;

2)? Strictly adhere to the principle of gradualness in increasing loads;

3)? Create certain conditions that reduce the possibility of re-injury. Here, various dressings and protective devices come first.

The most widespread in sports are elastic bandages and knee pads, ankles, orthoses, etc. Their purpose and indications for use are different. But all of them must reliably fix the damaged area. Another effective way protection weak points after injuries of the musculoskeletal system, "taping" is performed - fixation with adhesive plaster strips applied according to a certain system, and its type - "kinesio taping". The advantage of these methods is that during fixation, it is possible to more purposefully reduce the load on a certain muscle group, stabilize mobility in the joint, preventing pathological movements and completely preserving normal physiological movements.

Determine the time frame when an athlete can start full-fledged training and take part in competitions should be a "consultation" consisting of: traumatologist, team doctor (sports / personal doctor), coach, athlete.