With the course of various diseases, a stage may come when the use of medications is limited or becomes ineffective. In this case, one of the methods of treatment and rehabilitation can be physiotherapy, which is prescribed as monotherapy or as additional methods to the main treatment. The impact on the body of a number of physical factors contributes to the restoration of tissues and their physiological functions. In the NAKFF medical clinic, an individual treatment program is selected taking into account the condition and characteristics of the body. Our doctors have extensive experience in managing patients of various profiles, and the procedures are performed using equipment from well-known world manufacturers.

What determines the price of physiotherapy?

The consequences of diseases of the musculoskeletal system, nervous and some other systems, as well as various injuries are not always recoverable only by pharmaceutical means. In this case, it is useful to include in the treatment physiotherapy techniques that have shown their effectiveness, both in practice and in scientific research. Many of them are included in official therapeutic protocols.

We, as usual, follow a non-standard path of development. Sports medicine is no exception. Doctors and massage therapists work in teams. Recently, they began to talk about sports psychologists, rehabilitators appeared and, quite already, a strange profession for us - a sports physiotherapist. However, they are presented in Russia, exclusively in imported versions.

Let's try to understand what kind of animal this is - a sports physiotherapist. What unusual things does he know and why, in our country, there are no such specialists.

It turns out that everything is very simple. Sport Team- a very specific field of activity and, as a dogma, medical specialists working in it must have the appropriate specialized knowledge. Fundamentals of sports traumatology, sports nutrition, dietetics, taping, rehabilitation, handling simulators and physiotherapy equipment, basic knowledge of anatomy, sports physiology, medicine. It would seem that they are simple areas of knowledge, but put together, they give a profession that we call a sports physiotherapist (in Europe - a physiotherapist, overseas - an athletic trainer).A specialist with a special education, who has a wide range of theoretical knowledge and practical skills in sports medicine and has the right to make decisions independently.

Marvelous. But, if paid education in this specialization was introduced in our country, there would be no end to those who want to get such a prestigious profession. The competition among applicants would not be a joke. Our sports medicine needs such universal masters, they are expected in teams. An intermediate link between an athlete and a doctor. A person who closely takes care of the wards and solves issues that, at times, the hands of the team doctor do not reach due to being busy.

In many foreign professional teams, only physiotherapists work on a permanent basis. A doctor who has his own practice advises athletes and appears in the team when the need arises.

We do not have such specialists. Doctors and massage therapists are used to doing things on their own, solving issues within their competence, dividing these duties in incomprehensible proportions, reaching simple truths through their mistakes.

Wealthy clubs that can afford this luxury are sending physiotherapists from abroad. Look, Spaniards, Portuguese, Germans, Dutch, Brazilians work in our football.

Time dictates its own. There is a need to organize a training system for this profession. Professionals should work in modern sports medicine. It's a matter of small. Decide.

Goals and methods of sports physiotherapy.

Real-time monitoring and control of the functional state of athletes

Work to prevent sports injuries.

Injury prevention.

Rehabilitation after injuries and diseases.

Drawing up and adjusting short-term and long-term programs to bring athletes' problematic muscle zones out of the crisis.

Hardware physiotherapy.

First and pre-medical medical aid.

Close interaction and reciprocal assistance to team specialists working in related fields.

Observation of athletes at competitions and training sessions in order to develop their own professional recommendations and programs for adapting to loads and improving the performance of an athlete.

P.S. Six years after this article was written, a friend from Europe asked me to clarify just this issue.

I want to ask you for help and if you can let me know how the market for Physio (Physiotherapists) is organized in Russia?

Sports physiotherapist - there is no such profession in Russia. Sports doctors, masseurs, chiropractors, rehabilitators work in teams, recently specialists involved in kinesiology (not to be confused with kinesio taping) have appeared in clubs with money. Teamwork is limited by their competence and, as a rule, they rarely go beyond it. Nutrition is handled by the team doctor, with injured players - a rehabilitation specialist, masseurs and doctors tap, muscles and joints - kinesiologists and chiropractors, hardware physiotherapy - a doctor, etc.

The few specialists who work in clubs with money, labeled as "physiotherapists" are expats, i.e. foreigners working under a contract and educated in their home country. If there is a Russian surname among physiotherapists, then this is a massage therapist who has been promoted to a physiotherapist for some merit. But this is an exception, because there is no “sports physiotherapist” rate (i.e. such a profession).
Accordingly, there is no market for physiotherapists in Russian sports.

What do you need to finish to become a physiotherapist - school, academy, medical school, medical school, courses.....? How long does the learning process take?

Sports physiotherapists, in the sense that they are in Europe or like an athletic trainer in America, are not trained anywhere in Russia.

How many Physiotherapists are there in Russia?

See the article on the site. Article written 6 years ago

Are Physiotherapists organized in associations?

There is no association for sports physiotherapy in Russia. Nominally in Europe atENPHErepresent Russian sports physiotherapistsRGUFKSMiT represented by the Department of Physical Therapy, Massage and Rehabilitation

How is the work of a physiotherapist in a team built, what are the relationships with athletes?

Foreign sports physiotherapists who come to Russia have a very vague idea of professional sports, and sports medicine in the team in the Russian interpretation, especially in football, generally baffles them. And if someone did not earn money on them, then these "specialists" could be expelled in a couple of months. "Survive" those who begin to feverishly look around and actively adopt the techniques, methods, behavior and relationships with the players working alongside sports massage therapists, rehabilitation therapists, doctors, fitness trainers. Our "delightful" attitude towards foreign specialists helps them a lot. In short, those who quickly pick up someone else's experience, shaping their own, survive.

How to become a Physiotherapist of the National teams, the Olympic team, etc. ?

Expats - through agents. Their salaries are good, there is something to pinch off.

There is no such profession in the register of professions in Russia. There is a sister in massage (medical education - medical school), there is a doctor in sports medicine, there are massage therapists (sports education, massage courses in parallel). Accordingly, there are no sports physiotherapists in state structures. There are doctors and massage therapists, rehabilitation therapists with psychologists.

How and where do physiotherapists buy their daily sports medicine products, such as teips?

The purchase is carried out either by the chief doctor in the team, or by a special department, which, at the request of sports medicine specialists, completes the team with medicines.

Are there any special exhibitions for sports physiotherapists that sports professionals attend or attend to meet companies, each other, and learn about sports medicine products and innovations?

No. Within the framework of all-Russian forums, symposiums, conferences on sports medicine, topics are touched upon and included, master classes are held with a set of topics that are within the competence of sports physiotherapy.

Physiotherapy methods are offered for practical application as a means of correcting limiting factors sports result, recovery during training sports qualities. Physiomethods can reduce the pharmacological burden.

Physiotherapy, having a wide range of therapeutic and preventive 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 sports enthusiasts as an effective, timely, individual, methodically exact tool.

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

table 2

Means of rehabilitation of a sports injury by periods

Galvanization, electrophoresis, ultraphonophoresis of vasodilators, infrared irradiation, low-frequency magnetotherapy, warming compress, fresh baths (local), water heater, red laser therapy, ultratonotherapy.

Fibromodulating methods

Ultrasound therapy, electrophoresis of defibrosing agents, pelotherapy.

Myostimulating methods

Diadynamic therapy, amplipulse therapy, interference therapy, transcutaneous electrical neurostimulation, hydromassage (underwater douche-massage).

Basic principles of trauma treatment

1. The presence of pain syndrome requires its relief during the first 2–3 procedures, since anti-inflammatory therapy is less effective until pain disappears, just as uncontrolled edema prevents thermal exposure.

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

The probability of specific effects is higher with local and segmental, non-specific - with a generalized impact of physical factors.

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

1) Removal of post-traumatic stress;

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

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

4) creating a certain psychological background for the athlete, helping him quickly move on to full-fledged training;

5)? maintenance of general and special fitness.

On the solution of these problems, the whole complex of activities with a therapeutic and training orientation is built, including various types of special physical and psycho-emotional exercises, physiotherapeutic techniques that are quite well developed (respectively, the type, localization and complexity) for all its periods.

The following forms apply exercise:

- morning exercises;

- therapeutic exercises aimed at the rehabilitation of the lost function;

- special training sessions.

morning exercises includes a complex of general developmental physical exercises familiar to 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 the clinical manifestations and the stage of treatment of the injury and can be used during the period of immobilization, the post-immobilization period, the period of complete functional rehabilitation.

period of immobilization. A fixing bandage is 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 pronounced), active movements are used in the joints free from immobilization and ideomotor training, when the athlete mentally strains the muscles and makes movements in the joints, and also mentally imagines some training and competitive movements.

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

Athletes have a high accuracy of muscle-motor perception, therefore, if they have not previously engaged in ideomotor training, they quickly learn to mentally strain their muscles and figuratively imagine the execution of movements characteristic of the chosen sport. Sessions of ideomotor training 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, holding a straightened tense limb on weight - 10 seconds of tension and 20 seconds of relaxation (with repetition). In this case, the effort should increase gradually and reach its maximum value at the 6-7th second. The rest period after each exercise should be sufficient. Isometric exercises make it possible to selectively work on various muscle groups. The complex consists of 4-6 exercises performed from various positions - sitting, lying on your back, stomach, on your side. It is desirable to carry out exercises at least 2-3 times a day for 10-15 minutes.

Isometric exercises allow not only to maintain a sufficiently high muscle tone, but also to maintain 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 the joints (for a 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 that are diverse in physical properties and therapeutic effects. A special place among them is occupied by heat and hydrotherapy procedures.

Thermotherapy procedures are the impact on the body of therapeutic mud, paraffin, ozocerite, which to varying degrees affects physical thermoregulation, promotes expansion of peripheral vessels and redistribution of blood, stimulates respiration, has anti-inflammatory and absorbable effects, promotes tissue repair.

Hydrotherapy procedures are the impact on the body of fresh water and mineral waters(sometimes prepared artificially). 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 physiotherapeutic procedures, massage, that is, after muscle relaxation, a decrease in resistance to stretching. All this contributes to a more free, stress-free exercise.

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

In the early days, all movements are performed under 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 rate of active movements, i.e. movements that can be performed independently, and passive movements, i.e. movements that a doctor, nurse, exercise therapy instructor helps to perform. Indicators of passive movements usually exceed those of active movements. The greater the difference between these indicators, the greater the reserve extensibility, and hence the possibility of increasing the amplitude of active movements.

For example, the main means of restoring the full range of motion in the joints is stretching exercises (active, passive and active-passive). These include exercises for flexion, extension, as well as abduction and inclination, which allow, in a complex and selectively, to influence the musculoskeletal apparatus or those parts of it that limit the mobility of the joints. These exercises should be combined with muscle relaxation exercises, such as those aimed at conscious-voluntary muscle relaxation. These include exercises to relax the arms and shoulder girdle - the body is in a half-tilt forward, the arms hang freely; raise your shoulders up and, relaxing them, lower them, making rocking movements.

Most of the exercises for the development of the joints are performed in a dynamic mode in the form of rhythmic smooth movements. The number of these movements in each series is 8-12, since a separate short-term effect on the muscle-ligamentous groups is practically of no benefit. In addition, you can apply elastic or springy fixation in the final part of each movement, while increasing the amplitude in the series to the maximum.

As the range of motion increases, you can begin to exercise with additional weights that enhance the effect of tensile forces.

When developing movements, one should adhere to the principle “less is better, but more often”, therefore, no more than 5–6 series of exercises are included in each session and they are performed 10–12 times daily.

Restoration of muscle strength during this period is achieved with the help of strength exercises(better for special simulators), with the alternation of 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 make it possible to provide a protective mode of work in the injured sections of the musculoskeletal system with a simultaneous significant load on healthy sections.

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. Initially used simple exercises, and then exercises with a small weight, performed at an average pace. The number of repetitions is the 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 the growth of fitness, the load should be gradually increased due to the number of repetitions, and not by increasing the weight of the burden.

The amount of weight, 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 course of recovery processes and the individual capabilities of the athlete.

Rest intervals between sets should be longer than usual and ensure full recovery from the previous load. Relaxation exercises can be used as active rest in pauses. In this case, muscle relaxation is carried out somewhat differently than when developing joints: more quickly, completely, and after their preliminary tension. Relaxation exercises should be combined with breathing exercises, which in a reflex way contribute to the improvement of muscle relaxation.

For example: in a sitting or lying position, take a deep breath, hold your 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, exhaling slowly, relaxes the muscles. The exercise is performed 5-6 times, with each time the degree of relaxation increases.

Apply and static exercises. Static (isometric) exercises are selected in such a way that the effort is focused on the main or critical moments of the competitive movement. The principle of isometric strength training during this period is the active tension of the trained muscle or muscle group and maintaining this tension for a certain time. The most effective tension for 6–8 s with a 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 that are lifted to a small height and maintained for a given time;

- tension using a spring or elastic elastic resistance.

The rational alternation of strength exercises of a dynamic and static nature makes it possible to avoid sharp pain in the muscles and joints, which often occur 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 restoring the strength of a damaged limb up to 75–80%, compared with a healthy one, it is possible to include exercises on special training devices imitating training equipment in the exercises.

In a complex of measures to restore strength, as an additional means of muscle training, electrostimulation of muscles and tonic massage.

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

A training method for the rehabilitation of athletes with vertebrogenic pain syndrome (VPS) in 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 to learn the skills to work using a selected muscle group.

The main stage is aimed directly at working with specified muscle groups, the violation of which led to the formation of a leading pathological link. The achievement of the clinical goal is determined by: a decrease in pain, up to their cessation, overcoming the symptoms of muscle fatigue, an increase in the level of loads, an increase in the volume and strength of movements in the spine. The author of the method indicates that the achievement positive results confirmed by objective data by recording electromyographic (EMG) signals during EOS sessions. Depending on the task, it is possible to record the integral EMG during the 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 in order to strengthen the acquired motor skill.

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

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

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

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 subsidence of acute pain already in the immobilization period, in the post-immobilization period they occupy the main place and become more complete.

It is known that the complete cessation of training during an illness has a negative effect on the level of an athlete's fitness: not only his performance decreases, but also those specific motor skills, the recovery of which takes a long time in the future. A tool that contributes to the maintenance of general and special fitness is the selection of individual training exercises. It is important to choose exercises that, without the risk of re-injury, could compensate for the usual training load and, if possible, would preserve the motor stereotype of the special movement.

The motor mode 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 held 4–5 times a week with an average duration of 60 minutes, following the usual structure of a training session: preparatory, main and final parts.

The period of full functional rehabilitation. 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 pass one into the other. An approximate boundary can be the complete restoration of muscle strength and range of motion in the damaged zone (area), which can be determined by comparison with a healthy limb.

The main goal 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 the strength abilities characteristic of the chosen sport.

Perhaps the most responsible and difficult during the period of full 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 former maximum effort. Trauma memory is not limited to local changes. Trace pathological reactions in the subcortical zone of the brain significantly exceed the duration of the anatomical and functional recovery in the injured area on the periphery and are the main goal of the therapeutic effect.

To remove the negative psychological background, you must follow the following rules:

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) to create certain conditions that reduce the possibility of re-injury. Here, various dressings and protective devices come into play.

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 securely fix the damaged area. Another effective way protection of weak points after injuries of the musculoskeletal system is "taping" - fixation with strips of adhesive tape applied according to a certain system, and its variety - "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.

To determine the time when an athlete can start full-fledged training and take part in competitions, a “concil” consisting of: a traumatologist, a team doctor (sports / personal doctor), a coach, an athlete should determine.

Recently, among the biomedical means of restoring sports performance great importance attributed to physical factors. Physiotherapists are increasingly involved in the medical care of athletes. For example, among the medical workers serving the Olympic Games, more than half were physiotherapists. This is caused not only by the insufficient effectiveness 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 effective methods and methods of their application in the treatment of athletes.

In contrast to the previously widespread opinion about physical factors as non-specific irritants, the presence 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 the focus on a specific component of the action of physical factors, and consequently, on 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 physio- and balneotherapeutic methods for restoring sports performance has a number of significant advantages compared to many other medical and biological means. These methods are physiological, do not have a side effect, including an allergenic effect, 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 tissues, contribute to better utilization of oxygen and the fastest removal of decay products. With the correct appointment, taking into account the mechanism of action of each factor, 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 its performance and resistance to adverse environmental influences, accelerate recovery processes after intense physical activity.

When choosing and prescribing physiotherapeutic agents to restore the athlete's performance, one should be guided by the general principles of restorative measures (pedagogical, psychological, biomedical). First of all, it should be remembered that any recovery event will be effective only in combination with the optimal training regimen and the lifestyle of athletes.

When using physical factors, one should take into account the purpose of their appointment: increasing or restoring working capacity, using a factor for therapeutic or prophylactic purposes. In the preparatory period, when the athlete has a large volume and intensity of the load, it is recommended to carry out rehabilitation measures, which, contributing to the acceleration of recovery processes, create more favorable conditions for the subsequent training and increase the performance of the athlete as a whole. In 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. At the same time, it should be taken into account 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 loaded more and recover more slowly with a certain type of work in a particular sport, take into account heterochronism and phases of recovery processes in the athlete's body. A rational combination of methods of general and local effects is recommended: the former have a non-specific general strengthening effect; the latter help relieve fatigue of certain muscle groups by improving blood circulation and metabolic processes in tissues.

The observations made show that carbonic baths have a beneficial effect on the regulatory mechanisms of activity. of cardio-vascular system, primarily a cardiac factor of hemodynamics, increasing the stroke output of the heart. When they were used to restore sports performance, there was a decrease in energy costs for the activity of the cardiovascular system 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 helped to reduce the increased tone of the sympathetic nervous system of athletes who were in a state of fatigue after intense training loads, increased physical performance and aerobic capacity for energy supply. Simplicity and availability of sodium chloride bath procedures, their high efficiency allows us to recommend them to restore the health of athletes.

A highly effective method of restoring sports performance is a combination of a hydroelectric bath with underwater jet massage in one procedure. 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, lactic acid content in the blood), “super recovery” is also observed, which indicates that the athlete’s body has reached a higher functional level. Obviously, the effect of such exposure to several physical factors is carried out through the simultaneous activation of a number of extra- and proprioreceptors, which helps to reduce the heterochronism of recovery processes. As a result, almost simultaneously and to a sufficient extent, all links in the energy supply of muscle 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 the overall effect, significantly increasing the performance of athletes.

For a number of years, the Central Research Institute of Balneology and Physiotherapy has been developing methods for restoring sports performance using a low-frequency rectangular pulsed current (with the electrodes in the oculooccipital location), which causes electrosleep. The leading role in the mechanism of action of electrosleep is played by the direct influence of a rectangular pulsed current, mainly on the subcortical-stem 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 contributes to the optimization of energy processes. All this helps to accelerate the recovery of the athlete's functional capabilities. Electrosleep procedures with a pulse frequency of 10-20 Hz normalize hemodynamic parameters, reduce increased tone sympathetic nervous system, improve the functional state of the central nervous system. Indications for the appointment of these procedures are fatigue, overtraining, emotional stress, sleep disturbance.

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

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

An effective method of restoring and improving sports performance are sinusoidal modulated currents (SMT) generated by the Amplipulse apparatus. As the works of scientists from our institute have shown, these effects cause irritation of nerve receptors and contraction of a large number of muscle fibrils, which provides micromassage of peripheral vessels, improves blood circulation in the 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, and the plastic materials of the muscles are spent more economically. SMTs also have pronounced 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 exchange rate exposures of SMT during the preparatory period training cycle improve the performance of athletes. Carrying out these procedures in a stimulation mode 10-15 minutes before the start makes it possible to achieve an increase in the performance of athletes directly during the pre-start preparation.

At present, we pay great attention to the study of the possibilities of using electromagnetic oscillations of the ultra-high frequency (UHF) of the decimeter range when exposed to the area of ​​the most tired muscles after training and to the projection area 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 under the influence of decimeter waves (UHF) on the endocrine glands. An immunostimulating effect of UHF was also established when exposed to the area of ​​the thyroid gland and an immunocorrective effect when exposed to the projection area of ​​the adrenal glands.

Based on these data, it is proposed to use the impact of UHF on the projection of the adrenal glands in the preparatory period of the training cycle, and on the thyroid gland - in the competition.

Research on the application of physical factors in elite sports has led to the development of more than 15 guidelines which are 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 and contributed to the achievement of high sports results.

Vitasite https://www.site

The most important theoretical and methodological position of the concepts 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 addressing the issue of using physical means to restore and improve physical performance athletes. Currently, a number of methods have been developed to influence the course of adaptation and recovery processes in the body of an athlete by electro- and hydrobalneological procedures, which are successfully used both at different stages of the preparatory period of the training cycle and during competitions. The variety of physical characteristics and a wide range of these procedures, various options for localization, determine the feasibility of their use not only as a means of restoring or increasing performance, but in some cases as ways to increase the body's protective and adaptive reactions and prevent the occurrence of prepathological and pathological conditions in athletes.

The use of physical factors in sports medicine is justified by a number of reasons:

• sports loads increase to the limit, often athletes train on the verge of pre-pathological and pathological conditions, situations of acute and chronic overstrain of various organs and systems are frequent. This leads to the search for new methods and methods of recovery in sports, which is especially important in children's and youth sports and in sports of high achievements;
• 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 a person, due to which they are generally well tolerated, healthy athletes usually have no contraindications,
• when using physiotherapeutic factors, the drug load on the body, on the gastrointestinal tract does not increase, the allergization of the body does not increase;
• with the proper use of physical methods, a selective effect on various organs and systems, functions, and various links of recovery is possible; at the same time, simultaneous influence on many functional systems of the body is possible; 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, an evidence base for the positive effect of physiotherapy is being formed.

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

1. in rehabilitation after injuries and diseases;
2. in the system of restoration of 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. Medical, among others, include physiotherapy. Their use is regulated by the Order of the Ministry of Health and Social Development N 613n dated 09.08.2010 "On approval of the procedure for providing medical care during physical culture and sports events. In particular, the Order also established the procedure for providing medical care during rehabilitation measures after intense physical exertion in sports, after illnesses 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 sportswear athlete at any given time. A team of specialists has been identified who make up a program of rehabilitation measures after intense physical exertion, which includes a physiotherapist. Carrying out rehabilitation measures is possible at the medical center of the sports object, in the medical and physical education dispensary, the center physiotherapy exercises and sports medicine, in the rehabilitation department of a medical organization. For the organization of physiotherapy care in the medical and sports dispensary, 1 position of a physiotherapist for 5 positions of sports medicine doctors, positions of physiotherapy nurses and the organization of a physiotherapy department are provided.

The list of applied factors is wide and varies by different authors. The main physical factors in the system of post-exercise recovery of athletes:

• massage;
• hydroprocedures - underwater shower-massage, Scottish shower, bath-sauna: baths: contrast, vibration, pearl, sodium chloride, coniferous, carbonic, iodine-bromine, turpentine, etc.;
• electrolight procedures - electrical stimulation, amplipulse therapy, local pressure chamber, baromassage, electrosleep, magnetotherapy, galvanization, air ionization, electroacupuncture, laser therapy, decimeter wave therapy, laser therapy, light therapy, hypoxicators;

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

The literature provides principles for choosing means of recovery and ready-made complexes physiotherapy procedures.

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

1. Means that have a general effect on the body- physiotherapeutic procedures of general action: baths, showers, electrosleep, electroprocedures, carried out according to reflex-segmental methods. These procedures are the basis of recovery measures, they are prescribed when fatigue is widespread, it captures a number of physiological systems of the body, and is 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, can be both quite complete and shortened.
2. Local influences. Usually these are electroprocedures performed on the area of ​​muscles tired after physical exertion. More often, for this purpose, sinusoidal modulated currents (SMT) and a microwave electromagnetic field (EMF microwave) are used - decimeter wave therapy (UHF therapy).

The procedures mainly have a selective effect on the neuromuscular apparatus, relieve the feeling of fatigue, “clogged” muscles, pain sensations, help to urgently restore anaerobic processes in the muscles, and improve blood circulation. Procedures are prescribed after performing training loads of a speed-strength orientation or any other loads that lead 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 various physical factors on the area of ​​the adrenal glands, the thyroid gland are described - physical performance grows more actively, the immune system stabilizes, and a pronounced immunostimulating effect is manifested. However, any interference with the immune and endocrine system is fraught with serious consequences and complications in the form of failures in the operation of these systems and subtle mechanisms of neuro-humoral regulation and is dangerous.

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

1. The principle of individual approach.
2. 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 fully as possible and compensate for violations.
3. Long-term use of electrotherapeutic or balneotherapeutic procedures alone is not recommended, as the body adapts to them, which leads to a decrease in efficiency. Prolonged use of physical factors can impair the natural ability to recover.
4. Methodological approaches to the use of PT 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 intervals of time.

For example, during the period of intensification of training loads, when separate days microcycle full 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, pre-competitive and post-competitive periods, during rehabilitation measures for athletes who have an inadequate response to training loads or have signs of severe fatigue.

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

The number of PT procedures and the intervals between them are set taking into account the entire complex of restorative measures. If a wide complex 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 you need to restore body functions.

5. Accounting for the level of fatigue of the athlete. With the development of acute fatigue and the appearance of the first signs of overwork and physical overstrain, physical factors are selected 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), the duration of the procedure , frequency of alternation. In the presence of a sharp fatigue or overwork, preference is given to local procedures, or first, physical factors are used according to local methods, and then, as the functional state of the athlete improves, they switch to procedures that have a general effect on the body.
6. Combination of procedures.

• procedures of general and local action are well combined.
• a good effect - when using the same factor simultaneously according to segmental-reflex and local methods of exposure (for example, SMT or EMF microwave).
• hydrotherapy procedures and general thermal therapy (sauna) can be prescribed in combination with partial manual or vibration massage, pulsed currents and microwave therapy for muscles. Sometimes the second, local, procedure is prescribed immediately, sometimes after 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 they 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).

Assign 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 procedure is usually carried out the next day after the first or later.

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

7. Mandatory medical supervision. The complex of restorative physiotherapy is prescribed by a doctor, who subsequently controls the adequacy of the impact on 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 mechanisms energy supply)	Carbon dioxide baths, water and dry Baths from the "white" emulsion of turpentine and mixed turpentine Iodine-bromine baths SMT on the cervicothoracic region
Neuromuscular apparatus (anaerobic mechanisms of energy supply)	SMT on the most loaded muscle groups EMF microwave on the most loaded muscle groups Sodium chloride baths Baths from the "yellow solution" of turpentine and mixed turpentine
CNS (psycho-emotional state)	Sedative effect: ES with a pulse frequency of 10-20 Hz Iodine-bromine baths Coniferous baths Tonic effect: ES with a pulse frequency of 90-100 Hz Sodium chloride baths Baths from the "white" emulsion of turpentine
The immune system	EMF microwave on the projection area of ​​the thyroid gland EMF microwave on the projection area of ​​the adrenal glands EMF microwave on the collar area SMT on the cervicothoracic region paravertebral Total ultraviolet exposure

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

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

1. Manual massage, UHF therapy, warm shower;
2. Sauna, manual massage, amplipulse therapy;
3. Sauna, swimming pool, electrophoresis;
4. Galvanic vibration, segmental massage, acupuncture;
5. Contrast shower, baromassage, galvanization;
6. Amplipulse therapy, circular shower, local manual massage;
7. Foot baths, vibration massage, rain shower, magnetotherapy;
8. Underwater jet massage, rain shower, magnetotherapy;
9. General massage, sauna, electroacupuncture;
10. Contrast bath, local massage, diadynamic therapy;
11. Inductothermy, segmental massage, suggestion methods;
12. Baromassage, hygienic shower, ultraviolet irradiation;
13. Swimming in the pool;
14. Electrical stimulation, acupuncture, manual massage;
15. Warm shower, galvanization, segmental massage;
16. Electrical stimulation, baromassage lower extremities, warm shower;
17. Sollux, electrosleep, swimming pool;
18. Local hand massage, vibration massage, warm hand shower;
19. Warm shower, swimming pool, suggestion methods,
20. Contrast shower, baromassage, electrophoresis.

IN last years the complexes actively use magnetotherapy, cryotherapy, aeroionotherapy, chromotherapy.

The use of complexes differs taking into account the orientation of the training loads. In table. 2 shows the complexes of recovery procedures, taking into account the orientation of the loads of the previous and subsequent classes.

G.R. Gigineshvili offers his own complexes that have shown good clinical effectiveness:

1. sodium chloride baths (or contrast, “white” turpentine, carbonic) before training and electrosleep using a 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 coniferous, nitrogen) baths after it.

Such active sets of procedures are carried out in the most critical 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 restorative procedures, taking into account the direction of the loads of the previous and subsequent classes

The focus of the second lesson

The focus of the first lesson	Restorative means
Speed-strength	A. Massage. Irradiation with visible rays of the blue spectrum. Warm eucalyptus bath. B. Warm bath (eucalyptus, aromatic, nitrogen, coniferous, iodine-bromine). SUV irradiation, chromotherapy, general low-frequency magnetotherapy, general cryotherapy	Aerobic
Aerobic	A. Oxygen bath. Tonic rub. Aeroionization. B. Alpha massage, aeroionotherapy, aerophytotherapy Oxygen, pearl bath.	Anaerobic
Anaerobic	A. Hyperbaric oxygenation. Carbonated bath. Hydromassage. B. Normobaric hypoxic therapy. Souls. Hydromassage, Carbonic bath (gas or dry)	Aerobic

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

Physical factors and physiotherapeutic procedures are actively used for the prevention of fatigue, the correction of overwork and for the treatment of emerging maladaptation.

For the prevention of fatigue, physical factors are used for prophylactic purposes in sports associated with a long duration of competition and repeated performances (weightlifting, gymnastics, fencing, martial arts, all-around, etc.). Wherein physical methods divided into groups:

1. Methods of general stimulating action;
2. Psycho-emotional state modulation methods;
3. Antihypoxic and hemostimulating methods.

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

• haemomagnetotherapy and general magnetotherapy. The method acts through the influence on the vegetative nervous system and, in particular, its higher divisions - the hypothalamic-pituitary system, the reticular formation. As a result, synchronization of the bioelectrical activity of the brain, a change in conditioned reflex activity, an improvement in cerebral circulation, and an improvement in psychomotor qualities are manifested.
• thermomagnetotherapy;
• laser irradiation of blood;
• general air cryotherapy;
• aeroionotherapy;
• extremely high frequency therapy;
• round-the-clock aerotherapy
• oxygen therapy - in the form of inhalation of oxygen at atmospheric pressure;
• hypoxic therapy - normobaric interval and periodic hypoxic therapy (inhalation of a mixture with a low oxygen content in short intervals of 5 minutes, alternating with inhalation of air and, accordingly, long-term - 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 influence on the function of the central nervous system and psycho-emotional state, since CNS overstrain is essentially the first phase of sports sickness.

To restore the function of the central nervous system and restore the functional state of the athlete, the following are used:

• first of all, 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 occupied by physiotherapeutic procedures in the treatment of frolicking maladaptation. The most common maladaptation 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. In table. 3 systematizes the physical methods used for the correction of asthenic syndrome.

Table 3

Physical methods of treatment of patients with chronic fatigue syndrome

Methods	Procedures
Actoprotective	General air cryotherapy, electrosleep therapy, medium and high pressure showers, wet wraps
Sedatives	Electrosleep therapy, general low-frequency magnetotherapy, galvanization of the brain and segmental zones, drug electrophoresis of sedatives, tranquilizers and antidepressants, local darsonvalization of the head and collar zone, iodine-bromine, coniferous and nitrogen baths, aerophytotherapy of sedatives, round-the-clock aerotherapy.
Psychorelaxing	Selective chromotherapy, vibration massage relaxation, audiovisual and volumetric acoustic relaxation, alpha massage, lithium drug electrophoresis
Tonic	Therapeutic massage, contrast baths, thalasso-tearpy, medium pressure showers, aerophytotherapy with tonic preparations, general ultraviolet irradiation (medium and long wavelengths)
Vegetocorrective	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, aeroionotherapy, hydrogen sulfide baths, medium and high pressure showers, climatotherapy
Immunostimulating	Heliotherapy, laser blood irradiation, inhalation therapy of immunomodulators, drug electrophoresis of immunomodulators, high-frequency magnetotherapy of the thymus.

In addition, when applying physical factors, the preparation period (annual training cycle) is necessarily taken into account.

A. In the preparatory period:

• at the beginning of the preparatory period, procedures of general action 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 indicated - they positively affect the state of vegetative functions, the state of the musculoskeletal system, increase efficiency;
• towards the middle and end of the preparatory period, more attention is paid to the development of special qualities, techniques, speed-strength qualities, therefore, methods are more often used that contribute to the removal of fatigue in the most loaded organs and systems.

B. In the pre-competitive and competitive period.

• the athlete is at the peak of sports form, but high demands are placed on his psycho-emotional state, immune system. Restorative procedures are prescribed, especially electrosleep with a frequency of 10-20 Hz, iodine-bromine baths are indicated. 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 positively affect the metabolism of the heart muscle (amplipulse or decimeter wave radiation on the collar zone).
• sinusoidal modulated currents to the most loaded muscles in front of the strata - 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 in cyclic sports and is not indicated where a subtle muscular feeling is needed, which can be reduced due to the analgesic effect of the procedure.
• during the competitive period do not apply new previously untested procedures.

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

Thus, the range of application of physiotherapeutic factors and methods in the system of restoring physical performance and improving the physical condition of the athlete's body is wide and varied. Proper 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 the knowledge and joint work of a physiotherapist, sports medicine doctor and trainer.

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

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