1. Clinical examination is the main component of treatment and prophylactic measures and is a scientifically grounded system of preventive and therapeutic and diagnostic measures aimed at maintaining, strengthening and restoring human health.

The prophylactic medical examination of servicemen of the Armed Forces of the Russian Federation is understood as the system of work of the medical service of military units, formations, military medical units and institutions, aimed at preserving, strengthening and restoring the health of servicemen and providing for dynamic monitoring of the health of healthy servicemen, servicemen suffering from chronic diseases or acute diseases with risk factors for the development of chronic diseases, as well as for military personnel whose service is associated with the impact of unfavorable environmental factors.

A systematic analysis of the health status of servicemen, the study of their psychological and mental status, morbidity and its causes, the quality and effectiveness of clinical examination.

The main tasks of the medical examination of military personnel are the timely early detection of signs of diseases, the prevention of the risks of their development and the implementation of all therapeutic and prophylactic measures prescribed to servicemen, including measures of primary and secondary prevention.

4. Primary prevention measures are understood as a complex of organizational, therapeutic and prophylactic, hygienic, anti-epidemic and educational measures aimed at preventing diseases by improving the conditions of service and life of military personnel, strict compliance with sanitary standards and the requirements of the charters of the Armed Forces of the Russian Federation on the placement of military personnel, their organization food, water supply, fulfillment of the daily routine and the regulations of service time, rational use of days off by servicemen, rest before joining the outfit and after serving, timely and complete bringing to each serviceman the prescribed norms of allowance, eliminating or reducing to the established limits the influence of environmentally hazardous natural and anthropogenic factors on the health of servicemen, psychoprophylaxis.

5. Measures of secondary prevention include a set of measures aimed at preventing exacerbations and relapses of diseases, as well as the progression of chronic diseases. Timely, complete and adequate treatment of some diseases (acute tonsillitis, acute respiratory diseases) is at the same time the primary prevention of other more serious diseases (rheumatism, pneumonia, chronic bronchitis).

Elimination of risk factors for disease can refer to both primary and secondary prevention measures (for example, smoking cessation is the prevention of lung cancer, chronic obstructive pulmonary disease; elimination of hypokinesia in healthy military personnel and patients with circulatory system diseases is aimed at preventing the development of coronary heart disease) ...

Constant medical monitoring of the living conditions of personnel: accommodation, food, water supply, bath and laundry services for servicemen, as well as daily medical monitoring of servicemen in the process of combat training and in everyday life in order to identify factors that negatively affect the health of servicemen;

Monitoring the observance of the diet of military personnel in the following areas: first, monitoring the nutrition of healthy and practically healthy military personnel in order to prevent obesity and the development of diseases gastrointestinal tract; the second is the right organization diet food military personnel suffering from diseases internal organs.

The development of alimentary-constitutional obesity is caused by overeating and alcohol intake, a mismatch in calorie content daily ration actual energy consumption, violation of the working day, physical inactivity, uneven unbalanced nutrition.

7. Of universal importance in the prevention of diseases, especially diseases of the circulatory system, is the fight against hypokinesia in servicemen with military specialties, in which motor activity is reduced.

Propaganda healthy way life, including the prevention of drug addiction, substance abuse, alcoholism and tobacco smoking, which is organized by the deputy commander of the military unit for work with personnel in cooperation with military law enforcement agencies, the head of the medical service of the military unit and the army community organizations operating at the military unit.

9. One of the directions of preventive work in a military unit is psychoprophylaxis. Psychoprophylaxis is understood as a set of measures aimed at preventing the development of mental disorders by preventing the action of pathogenic, primarily psycho-traumatic factors on the body, identifying persons with signs of neuropsychic instability, predisposed to personality disorders, alcoholism, drug addiction, early recognition of mental disorders, prevention of mental chronicity. diseases by carrying out medical and recreational measures to needy servicemen.

Along with the commanders (chiefs), responsibility for organizing work to preserve and strengthen the mental health of servicemen is assigned to:

For countering the spread of alcohol and drugs, educational work to prevent drug addiction, substance abuse, alcoholism and tobacco smoking among military personnel - for deputy commanders of military units for work with personnel, medical service;

For identifying persons predisposed to personality disorders, alcoholism, drug addiction - for deputy commanders of military units for work with personnel, medical service;

Features of medical control over the state of health of officers and military personnel undergoing military service under the contract, are due to the older age of this category of servicemen compared to the servicemen doing military service by conscription, the longer duration of service in the Armed Forces, the specifics of the performance of official duties, the nature of work, increased professional and household risk factors (psychogenic, physical, chemical, dyshormonal ). On the background age-related changes in various organs and systems, diseases in this category of servicemen acquire a chronic, mutually aggravating character, proceed sluggishly and atypically, with exacerbations and complications of the main process.

These features determine the need for the examination of military personnel by appropriate medical specialists.

Medical monitoring of the health status of officers and servicemen undergoing military service under contract in the course of their daily activities is carried out through a selective individual survey about the well-being of officers during combat training, their state of health, complaints, and some functional tests. Most attention is given to persons with an increased risk of diseases, as well as those under dispensary dynamic supervision.

Effective form medical monitoring of the state of health of officers and military personnel undergoing military service under contract is an in-depth medical examination, which is carried out in the IV quarter of the year. An in-depth medical examination of officers and servicemen undergoing military service under contract, under the age of 40, who are not under dispensary dynamic supervision, is carried out by a doctor of the military unit. According to medical indications, the necessary laboratory, functional, X-ray examinations and consultations are carried out by specialists of medical and preventive institutions.

Officers and military personnel undergoing military service under the contract, over the age of 40, as well as persons under dispensary dynamic observation, are examined with the obligatory participation of the necessary specialist doctors of medical and preventive institutions according to individual plans developed by the head of the medical service of the military unit with taking into account the recommendations of specialist doctors.

Before a medical examination of officers and servicemen serving under contract, the head of the medical service of a military unit writes in the officer's medical book a short epicrisis about the results of medical observation in the past year, about the diseases suffered during the year, their consequences, and for servicemen who are under the dispensary dynamic observation, - about the course of the main and concomitant diseases, exacerbations of the disease, labor losses for last year, and also assesses the completeness and effectiveness of the medical and preventive measures taken. The doctor of the military unit studies the opinion of the subject about the dynamics of his health, the conditions of service and life.

The obligatory scope of in-depth medical examination of officers and military personnel undergoing military service under contract includes:

organ fluorography chest;

general blood and urine tests; in addition, for persons over 40 years of age - a study of blood sugar, total cholesterol and triglycerides in the blood;

electrocardiographic examination - once every two years, and for persons over 40 years old - annually; on suspicion of ischemic disease an ECG is performed for the heart - a study with a stress test;

measurement of intraocular pressure for persons over 40 years old - once every two years;

anthropometry (determination of body weight, height, circumference of the chest and abdomen; spirometry, dynamometry);

examination by a doctor of a military unit (specialist doctor);

examination by a dentist.

A medical examination of the officers of the command and control of the formation and military units that do not have doctors and who are stationed in the same garrison with the medical department, military command, is carried out in their polyclinic departments, or in the garrison military polyclinic.

If the military personnel detects complaints, risk factors for diseases, manifestations of diseases, the doctor of the military unit assigns them the necessary additional laboratory, instrumental studies, consults them with the appropriate specialist. According to the conclusion of a specialist, a soldier is carried out additional research, consultations with other specialists, if necessary, a specialist assigns an inpatient examination in a medical institution.

At the end of an in-depth medical examination, the head of the medical service of the unit writes down a group of health status in the medical book (form 2), and if a disease is detected, a diagnosis, a group of physical training, and also prescribes the necessary therapeutic and preventive measures to those in need.

Servicemen over 40 years old, as well as persons who are under dispensary dynamic observation and who have undergone an in-depth medical examination by specialists, an entry in a medical book about a health status group, a group of physical training, basic and concomitant diseases, about medical and recreational measures assigned to a soldier, is done by a specialist doctor.

Based on the results of a medical examination, officers and servicemen undergoing military service under contract are divided into the following groups of health status:

Group I - "healthy" - these are persons who do not have diseases or their distant manifestations, the consequences of acute diseases and injuries, as well as military personnel who have revealed some deviations of a functional and morphological nature without a tendency to progression, which do not affect their working capacity and ability to perform duties of military service;

Group II - "practically healthy" - military personnel who have been diagnosed with diseases without disrupting the functions of organs and systems, which do not limit the ability to perform military service duties. This group also includes persons who have suffered acute illnesses, injuries, injuries, and having manifestations of their consequences, which do not significantly reduce working capacity, as well as persons with periodically exacerbated chronic diseases;

Group III - “those with chronic diseases”. This group includes military personnel who have chronic diseases with moderate dysfunctions of organs and systems and periodic exacerbations that reduce performance. This group also includes persons who have the consequences of injuries, poisoning, surgical interventions and other influences of external factors that reduce performance. Servicemen assigned to the third group of health status are subject to dispensary dynamic observation. V individually servicemen of the third group of health status are assigned the terms of control medical examinations (examinations) and the necessary medical and recreational measures.

A list of the main diseases for determining the group of health status of servicemen undergoing military service under a contract is given in Appendix 9 of the Guidelines for Medical Support of the Armed Forces of the Russian Federation in Peacetime.

Based on data on health groups of officers and servicemen undergoing military service under contract, as well as the requirements of the Manual on physical fitness and Guidelines for the medical provision of physical fitness, they are divided into the following physical training groups:

Group I - under the age of 30;

Group II - aged 31 to 35 years and transferred for health reasons from the first group;

Group III - aged 36 to 40 and transferred for health reasons from the first and second groups;

Group IV - aged from 41 to 45 years and transferred for health reasons from the first, second and third groups;

Group V - aged from 46 to 50 years old and transferred for health reasons from other groups;

VI - at the age of 51 and older.

Persons with a health status group "practically healthy" are engaged in physical training groups: at the age of 30-35 years - in III; 36-40 years old - in IV; over 45 years old - in the exercise therapy group.

At the end of the calendar year, based on the results of medical examination of military personnel, incl. Submitted by an in-depth medical examination, the head of the medical service of the military unit analyzes the dynamics of the health status of the officers, servicemen undergoing military service under contract and conscription, evaluates the completeness and effectiveness of the medical and preventive measures carried out during the year and reports summarized materials to the commander of the military unit. In a report 1 / honey. and the annual report in the form 3 / honey. the head of the medical service of the unit is provided with data on the completeness and quality of the in-depth medical examination of servicemen, on the effectiveness of medical examination of servicemen.

The report to the unit commander reflects the following issues:

the number of those surveyed in comparison with the payroll of the military unit;

data on the health status of servicemen, and the causes of morbidity, as well as on persons in need of dispensary dynamic observation, incl. about those lagging behind in combat training, in need of medical and recreational measures, inpatient examination and treatment, in sanatorium treatment, medical examination;

characteristics of changes in the state of health of servicemen in comparison with those of the previous in-depth medical examination with explanations of the reasons for these changes;

evaluation of the effectiveness of treatment and prophylactic measures carried out for Last year, as well as measures to be taken to improve the conditions of military service and life of military personnel;

a list of servicemen who have not undergone an in-depth medical examination, as well as subject to stationary examination and examination by the IHC.

Control medical examinations of military personnel,

The specifics of passing a physical training facility are regulated by the Manual on Physical Training in the Armed Forces of the Russian Federation, approved by order of the Ministry of Defense of Russia dated April 21, 2009 No. 200 (hereinafter referred to as the Manual). According to paragraph 232 of this Manual, it was established that a soldier who did not perform the prescribed physical exercise, or refused to pass the physical fitness test without a valid reason, is assessed according to it "unsatisfactory".

However, the same clause of the Manual provides for two conditions under which the mark on the day of delivery of the physical examination is not set:

1. In the event that a soldier is involved in serving in a daily dress, on alert and other on-duty units (forces) of a military unit, then they are not naturally involved in the check and therefore they are assigned a separate day for the delivery of the FIZO.

2. If a soldier is unable to perform a physical exercise due to illness or injury, then the examiner determines the exercise of the same quality, while the individual practical readiness of the serviceman is assessed.

In addition to the above two points, the Manual establishes (see paragraph 14) that military personnel who have deviations in their health status and those who, as a result of an in-depth medical examination for health reasons, are assigned to the 3rd or partially to the 2nd group, and also those who have suffered acute illnesses and injuries, who are under medical supervision at the conclusion of a doctor, to be checked physical fitness not allowed. Servicemen under the contract, who are under dispensary-dynamic observation, are tested for physical training after the end of such observation.

Let us emphasize that the serviceman should be given the opportunity to retake. This follows from the requirements of paragraph 12 of the Manual, which says that contract servicemen who have not fulfilled the established requirements for the level of physical fitness (who have not fulfilled the control standards for physical fitness) for inspection are given a five-month period to prepare and re-pass such an inspection. Commanders can set the time for additional training for servicemen who have not fulfilled the requirements for physical education.

At the same time, control over the fulfillment by servicemen of the established requirements for the level of physical training, over the provision and setting of time for them to prepare and re-pass (retake) the relevant standards, as well as to clarify the respectfulness (or vice versa) of the reasons for the non-arrival of servicemen for verification by governing documents is assigned to the commanders. , including those who check the level of physical fitness of these military personnel.

As for the 1010 prize, indeed, in accordance with paragraph 11 of the Order of the Ministry of Defense of the Russian Federation No. 1010, no additional material incentives are provided, including military personnel who have unsatisfactory results in physical training.

From the above, it follows that a serviceman who has unsatisfactory results in physical training due to failure to pass the relevant standards or refusal to pass the test for such training without a valid reason does not appear to be additional material incentives provided for by order of the RF Ministry of Defense No. 1010 dated July 26, 2010. However, in In the considered situation, the actions of the command in relation to the serviceman are illegal. The non-arrival for the check was forced, due to illness, that is, for a good reason. Consequently, failure to show up for FIZO for a good reason is not tantamount to a bad mark and a military man has the right not only to retake it, but also to be presented for a bonus.

Medical contraindications for sports. List of diseases and pathological health conditions that prevent admission to classes physical education and sports in educational institutions... Approximate terms for resuming physical education and sports after some diseases and injuries.

List of diseases and pathological conditions that prevent admission to sports

I. All acute and chronic diseases in the acute stage

II. Features of physical development

1. A pronounced lag in physical development preventing the performance of exercises and standards provided for curricula; a sharp disproportion between the length of the limbs and the body.
2. All types of upper limb deformities that exclude or impede the ability to perform various sports exercises.
3. Severe deformation of the chest, impeding the functioning of the organs of the chest cavity.
4. Severe deformity of the pelvis, affecting the statics of the body or disrupting the biomechanics of walking.
5. Shortening of one lower limb by more than 3 cm, even with a full gait; pronounced curvature of the legs inward (X-shaped curvature) or outward (O-shaped curvature) when the distance between the inner condyles of the femurs or the inner ankles of the tibia is more than 12 cm.

III. Neuropsychiatric diseases. Central and peripheral injuries nervous system.

1. Mental and non-psychotic mental disorders due to organic damage to the brain. Endogenous psychoses: schizophrenia and affective psychosis. Symptomatic psychoses and other mental disorders of exogenous etiology.

   Persons with a mild short-term asthenic condition after an acute illness are allowed to go in for sports after a complete cure.

2. Reactive psychoses and neurotic disorders.

   Persons who have had acute reactions to stress, adaptation disorders and mildly expressed neurotic disorders, characterized mainly by emotional - volitional and autonomic disorders, are allowed to go in for sports after complete recovery.

   Persons with rare fainting are subject to in-depth examination and treatment. The diagnosis of "neurocirculatory dystonia" is established only in those cases when targeted examination did not reveal other diseases accompanied by disorders of the autonomic nervous system. Even in the presence of rare fainting, such persons cannot be allowed to engage in martial arts, difficult coordination, traumatic and water sports.

3. Organic diseases of the central nervous system (degenerative, brain and spinal cord, congenital anomalies and other neuromuscular diseases).
4. Diseases of the peripheral nervous system (including the presence of objective data without dysfunction).
5. Peripheral nerve injuries and their consequences (including mild residual effects in the form of mild sensory impairments or slight weakening of the muscles innervated by the damaged nerve).
6. Consequences of fractures of the skull bones (cranial vault, facial bones, including the lower and upper jaw, other bones) without signs of organic damage to the central nervous system, but in the presence of a foreign body in the cranial cavity, as well as a replaced or unsubstituted defect in the bones of the cranial vault.
7. Temporary functional disorders after acute diseases and injuries of the central or peripheral nervous system, as well as their surgical treatment.

Persons who have suffered a closed trauma of the brain and spinal cord, with an instrumentally confirmed absence of signs of damage to the central nervous system, can be allowed to play sports no earlier than 12 months later. after complete recovery (traumatic sports are not recommended).

IV. Diseases of the internal organs

1. Congenital and acquired heart defects.
2. Rheumatism, rheumatic heart disease (rheumatic pericarditis, myocarditis, rheumatic valve defects). Non-rheumatic myocarditis, endocarditis. Other heart diseases: cardiomyopathies, organic disorders heart rate and conduction, valve prolapse (II degree and higher, I degree - in the presence of regurgitation, myxomatous degeneration of the valves, cardiac arrhythmias, ECG changes), ventricular pre-excitation syndromes, sick sinus syndrome.

   Rare single resting extrasystoles and sinus arrhythmias of a functional nature are not a contraindication for sports.

   Persons who have had non-rheumatic myocarditis without an outcome in myocardiosclerosis, in the absence of cardiac arrhythmias and conduction disorders, against a background of high exercise tolerance, can be allowed to play sports after 12 months. after complete recovery.

3. Essential hypertension, symptomatic hypertension.
4. Cardiac ischemia.
5. Neurocirculatory dystonia (hypertensive, hypotensive, cardiac or mixed types) - conditionally allowed.
6. Chronic nonspecific diseases of the lungs and pleura, disseminated lung diseases of non-tuberculous etiology (including diseases accompanied by even minor respiratory dysfunctions).
7. Bronchial asthma.

   In the absence of seizures for five years or more, but persisting altered bronchial reactivity, admission to individual sports is possible (sports aimed at developing endurance are not recommended, winter views sports, as well as sports that take place in the halls and are associated with the use of talc, rosin, etc.).

8. Peptic ulcer and duodenal ulcer in the acute stage. Peptic ulcer and duodenal ulcer in remission with impaired digestion and frequent exacerbations in history.

   Persons with gastric ulcer or duodenal ulcer who have been in remission for 6 years (without digestive dysfunction) may be allowed to play sports (sports aimed at developing endurance are not recommended).

9. Other diseases of the stomach and duodenum, including autoimmune gastritis and special forms of gastritis (granulomatous, eosinophilic, hypertrophic, lymphocytic), diseases of the gallbladder and biliary tract, pancreas, small and large intestine, with significant and moderate dysfunction and frequent exacerbations.

   Persons with Helicobacter pylori gastritis may be eligible for sports after appropriate treatment.

   Persons with chronic gastritis and gastroduodenitis with minor dysfunctions and rare exacerbations, as well as biliary dyskinesias with rare exacerbations, may be allowed to play sports.

10. Chronic liver disease (including benign hyperbilirubinemia), liver cirrhosis.
11. Diseases of the esophagus (esophagitis, ulcer - until complete recovery; cardiospasm, stenosis, diverticula - in the presence of significant and moderate dysfunction).
12. Chronic kidney disease (chronic glomerulonephritis, chronic primary pyelonephritis, nephrosclerosis, nephrotic syndrome, primary contracted kidney, renal amyloidosis, chronic interstitial nephritis and other nephropathies).
13. Pyelonephritis (secondary), hydronephrosis, urolithiasis.

    Instrumental removal or independent discharge of a single stone from the urinary tract (pelvis, ureter, bladder) without crushing stones of the urinary system, small (up to 0.5 cm) single calculi of the kidneys and ureters, confirmed only by ultrasound, without pathological changes in the urine, unilateral or bilateral nephroptosis of stage I are not a contraindication to sports.

14. Systemic connective tissue diseases.
15. Joint diseases - rheumatoid arthritis, arthritis combined with spondyloarthritis, ankylosing spondylitis, osteoarthritis, metabolic arthritis, the consequences of infectious arthritis.

    Persons who have had reactive arthritis with complete reverse development can be admitted to sports after 6 months. after a complete cure.

16. Systemic vasculitis.
17. Diseases of the blood and hematopoietic organs.

    Persons with temporary functional disorders after non-systemic blood diseases are allowed to play sports after complete recovery.

18. Persistent changes in the composition of peripheral blood (the number of leukocytes is less than 4.0x109 / l or more than 9.0x109 / l, the number of platelets is less than 180.0x109 / l, the hemoglobin content is less than 120 g / l).
19. Malignant neoplasms of lymphoid, hematopoietic and related tissues: lymph, myelo-, reticulosarcoma, leukemia, lymphosis, lymphogranulomatosis, paraproteinemic hemoblastosis (including conditions after surgical treatment, radiation and cytostatic therapy).
20. A history of acute radiation sickness of any severity, as well as a radiation dose previously received in an accident or accidental exposure, exceeding the annual maximum permissible dose by five times (in accordance with radiation safety standards - 76/87).
21. Endocrine diseases, nutritional and metabolic disorders (simple goiter, non-toxic nodular goiter, thyrotoxicosis, thyroiditis, hypotypeosis, diabetes mellitus, acromegaly, diseases of the parathyroid glands, adrenal glands, gout, obesity II-III degree).

V. Surgical diseases

Diseases of the spine and their consequences (spondylosis and related conditions, diseases of the intervertebral discs, other diseases of the spine, severe disorders of the position of the spine in the sagittal plane: rickety kyphosis, tuberculous kyphosis, Scheuermann's disease - May, Calvet disease; scoliotic disease, manifestations of pronounced instability) ...

Persons with an unfixed curvature of the spine in the frontal plane (scoliotic posture) and initial signs of asymptomatic intervertebral osteochondrosis may be admitted to symmetrical sports.

1. The consequences of fractures of the spine, chest, upper and lower limbs, pelvis, accompanied by dysfunctions.
2. Diseases and consequences of injuries of the aorta, great and peripheral arteries and veins, lymphatic vessels: obliterating endarteritis, aneurysms, phlebitis, phlebothrombosis, varicose and post-thrombotic disease, elephantiasis (lymphodema), varicose veins of the spermatic cord (moderate to significant severity); angiotrophoneuroses, hemangiomas.
3. Surgical diseases and lesions of large joints, bones and cartilage, osteopathies and acquired musculoskeletal deformities (intra-articular lesions, osteomyelitis, periostitis, other bone lesions, osteitis deformans and osteopathies, osteochondropathies, persistent joint contractures, other diseases and lesions of joints, bones and cartilage ).

   With Osgood-Schlatter's disease, the question of the possibility of admission to sports is decided individually.

4. Old or habitual dislocations in large joints that occur with minor physical exertion.
5. Defects or missing fingers that impair hand function.
6. Defects or absence of toes, impairing full support, making it difficult to walk and wear shoes (normal and sports).

   For the absence of a toe on the foot, it is considered its absence at the level of the metatarsophalangeal joint. Full flattening or immobility of the finger is considered as its absence.

7. Flat feet and other deformities of the foot with significant and moderate impairment of its functions.

   In the presence of II degree flat feet on one leg and I degree flat feet on the other leg, the conclusion is made on the II degree flat feet.

   Persons with flat feet of I degree, as well as II degree without arthrosis in the talonavicular joints can be allowed to play sports.

8. Hernia (inguinal, femoral, umbilical), other abdominal hernias. Expansion of one or both inguinal rings with a protrusion of the contents of the abdominal cavity clearly felt at the time of the annular examination during straining - until complete recovery.

   A small umbilical hernia, a preperitoneal wen of the white line of the abdomen, as well as the expansion of the inguinal rings without hernial protrusion during exercise and straining are not a contraindication to sports.

9. Hemorrhoids with frequent exacerbations and secondary anemia, prolapse of stage II-III nodes. Recurrent anal fissures.

   Persons who have undergone surgery for varicose veins of the lower extremities, veins of the spermatic cord, hemorrhoidal veins, cracks in the anus can be allowed to play sports if, after 1 year after the operation, there are no signs of recurrence of the disease and local circulation disorders.

10. Protrusion of all layers of the rectal wall when straining.
11. The consequences of injuries to the skin and subcutaneous tissue, accompanied by impaired motor functions or making it difficult to wear sportswear, shoes or equipment.

    Imperfect scars after operations and injuries, which, by their localization, make it difficult to perform physical exercise; scars prone to ulceration; scars that are soldered to the underlying tissues and impede movement in a particular joint during exercise.

12. Diseases of the mammary glands.
13. Malignant neoplasms of all localizations.
14. Benign neoplasms - until complete recovery.

Persons with temporary functional disorders after surgical treatment of benign neoplasms are allowed to play sports after complete recovery.

Vi. ENT injuries and diseases

1. Diseases and injuries of the larynx, cervical trachea, accompanied by even minor violations of the respiratory and vocal functions.
2. Curvature of the nasal septum with a pronounced violation of nasal breathing (the operation in such cases is carried out at the age of at least 15 years).
3. Diseases of the external ear - until complete recovery.
4. Diseases of the Eustachian tube - until complete recovery.
5. Purulent unilateral or bilateral epitympanitis or mesatimpanitis in all forms and stages.
6. Persistent residual effects of the transferred otitis media (persistent cicatricial changes in the tympanic membrane, the presence of perforation of the tympanic membrane).
7. Otosclerosis, labyrinthopathy, cochlear neuritis and other causes of deafness or persistent hearing loss in one or both ears (normally, in both ears, the perception of whispering speech should be at a distance of 6 m, the minimum allowable decrease in this distance is up to 4 m).
8. Violation of the patency of the Eustachian tube and ear barofunction disorder.
9. Vestibular-vegetative disorders, even to a moderate degree.
10. Diseases of the paranasal sinuses - until they are completely cured.
11. Deformations and chronic changes in the condition of the tissues of the nose, mouth, pharynx, larynx and trachea, accompanied by impaired respiratory function.
12. Diseases of the upper respiratory tract (polyps of the nasal cavity, adenoids, decompensated form of chronic tonsillitis) - until complete recovery.

    Chronic decompensated tonsillitis is usually understood as a form of chronic tonsillitis, characterized by frequent exacerbations (2 or more per year), the presence of tonsillogenic intoxication (subfebrile condition, rapid fatigue, lethargy, malaise, changes in the internal organs), involvement in the inflammatory process of lymph nodes, regional (paratonsillar abscess, regional lymphadenitis).

    The objective signs of chronic decompensated tonsillitis include: the release of pus or caseous plugs from the lacunae when pressing with a spatula on the tonsil or when probing it, rough scars on the tonsils, hyperemia and swelling of the palatine arches and their fusion with the tonsils, the presence of suppurative follicles in the subepithelial layer, an increase in follicles lymph nodes along the anterior edge of the sternocleidomastoid muscles.

13. Ozena.
14. Complete lack of smell (anosmia).
15. Persons with temporary functional disorders after exacerbation of chronic diseases of the ENT organs, their injuries and surgical treatment are allowed to play sports after complete recovery.

Vii. Eye injuries and diseases

1. Lagophthalmos, twisting of the eyelids and eyelash growth towards the eyeball, causing permanent eye irritation; eversion of the eyelids, disrupting the function of the eye, fusion of the eyelids between themselves or with the eyeball, preventing or limiting the movement of the eyes, disrupting the function of vision, at least one eye.
2. Ptosis of the eyelid, impairing the function of vision in one or both eyes.
3. 3. Persistent incurable lacrimation due to a disease of the lacrimal ducts.
4. Chronic diseases of the conjunctiva, cornea, uveal tract and retina of an inflammatory or degenerative nature with frequent exacerbations.
5. Diseases of the optic nerve.
6. Optic nerve atrophy.
7. Severe congenital and acquired (including traumatic)
8. cataract.
9. Clouding, destruction of the vitreous body.
10. Congenital and acquired defects in the development of the membranes of the eye, impairing the function of vision.
11. Afakia.
12. Changes in the fundus.
13. Conditions after a penetrating injury to the eye.
14. Foreign body in the eye, not indicated for extraction.
15. Limiting the field of view of one or both eyes to more than 20 °.
16. Locomotor system disorders of the eyes.
17. Severe nystagmus of the eyeball with a significant decrease in visual acuity.
18. Concomitant strabismus more than 20 ° - the issue of admission is decided individually.
19. Disorders of color perception - the issue of admission is decided individually, depending on the specifics of the chosen sport.
20. Refractive errors: general variant - visual acuity: a) less than 0.6 in both eyes (without correction); b) at least 0.6 for the best eye and 0.3 for the worst eye (without correction).

Approximate terms for resuming physical education and sports after some diseases and injuries
(from the beginning of a visit to an educational institution).

Name illness	Timing	Note
1	2	3
Angina	2-4 weeks	To resume classes, an additional medical examination is required, you need to pay special attention to the condition of the heart and its response to stress. If you have any heart complaints, exclude endurance exercises and avoid breathing-holding exercises for at least six months. Be wary of chills (skiing, swimming, etc.)
Acute Respiratory Disorders	1-3 weeks	Avoid refrigeration. Skiing, skating, swimming may be temporarily excluded. In winter, when exercising outdoors, breathe through your nose.
Acute otitis media	3-4 weeks	Swimming is prohibited. Beware of cooling. With vestibular instability, which occurs more often after surgery, such exercises that can cause dizziness (sharp turns, somersaults, etc.) are excluded.
Pneumonia	1-2 months	Avoid hypothermia. It is recommended to use more widely breathing exercises, as well as swimming, rowing, skiing
Pleurisy	1-2 months	Excluded for up to six months are endurance exercises and straining exercises. Swimming, rowing, winter sports are recommended. Regular monitoring is necessary due to the risk of tuberculosis.
Flu	2-4 weeks	It is necessary to monitor the reaction to the load during exercise, because in this case, you can detect a deviation from the side of cardio-vascular system not identified during examination at rest.
Acute infectious diseases (measles, scarlet fever, diphtheria, dysentery)	1-2 months	Only with a satisfactory reaction of the cardiovascular system to functional tests. If there were changes in the heart, then exercises for endurance, strength and those associated with straining are excluded for up to six months.
Sharp jade	2-3 months	Endurance exercises are prohibited forever. they, with normal kidneys, cause the appearance of protein and cellular elements in the urine. After starting physical education, regular monitoring of the composition of urine is necessary.
Rheumatic heart disease	2-3 months	At least a year are engaged in special group... Regular monitoring of the reaction of the cardiovascular system to physical exercise and the activity of the process.
Infectious hepatitis	8-12 months	Exercises for endurance are excluded, regular ultrasound monitoring of structural parameters, biochemical parameters of the liver is required.
Appendicitis (after operation)	1-2 months	In the first months, straining, jumping and exercises that stress the abdominal muscles should be avoided. In case of complications after surgery, the timing of the resumption of classes is determined individually.
Fractured limb bones	3 months	For at least 3 months, exercises that give a sharp load on the injured limb should be excluded.
Concussion	2-12 months	In each case, the permission of a neurologist is required. Exercises with a sharp shaking of the body (jumping, sport games, football, basketball, etc.)
Stretching of muscles and tendons	1-2 weeks	The increase in load and range of motion in the injured limb should be gradual.
Rupture of muscles and tendons	At least six months after operational interference	Preliminary long-term use of medical gymnastics.

Approximate terms of admission to training and competitions after certain diseases, injuries and surgical interventions in the upper respiratory tract and hearing organs

(V.A.Levando et al. 1985)

	Diseases	The main signs of recovery	Admission to training.	Competition admission.	Note
1	Angina (except phlegmonous)	Absence of inflammation in the pharynx, pain when swallowing. Normal temperature 3 days. General satisfactory condition. Urine, blood is normal.	12-14 days	12-20 days	For winter and water sports, the terms are extended by 4-5 days
2	Phlegmonous angina (peritonsilar abscess)	Same, but temperature normalization 7 days	14-20	20-30	Also, for 7-10 days
3	Retropharyngeal abscess)	Absence of inflammation in the pharynx. Satisfactory condition. Urine, blood is normal.	10-12	12-14
4	Pharyngitis is acute	Also	2-3	4-6
5	ARI (ARVI)	Normal temperature is 4-6 days. Urine, blood is normal.	5-8	10-12	Also, for 4-5 days
6	Acute sinusitis, frontal sinusitis, ethmoiditis	Normal temperature is 7 days. The disappearance of headaches. Urine, blood, sinus radiographs are normal.	7-8	10-12	Also, for 7-8 days
7	Acute otitis media without perforation	Hearing restoration, normal otoscopic picture	5-10	10-14	Take extra care when practicing water sports
8	Acute suppurative otitis media with perforation	Termination of purulent flow, scarring of perforation	14-20	20-30
9	Acute mastoiditis	Hearing restoration. Normal otoscopic picture	15-20	25-30	—
10	Facial nerve paresis	Full recovery	50-60	75-80	Suspended from water sports
11	Perichondritis of the auricle	Complete disappearance of inflammation phenomena	2-5	7-10	Special care in martial arts
12	Furuncle of the nose	Complete disappearance of the phenomena of inflammation. Urine, blood is normal.	2-5	7-10	When practicing water sports, the period is lengthened
13	Acute labyrinthitis	All sports are prohibited for 1-2 years			—
14	Ruptured eardrum	The same as in acute otitis media			—
15	Laryngeal edema	Sports activities are prohibited until complete recovery. In case of relapses - suspension from sports			—
16	Tonsillectomy	The postoperative period was uneventful. Absence of inflammation in the pharynx	25-30	30-40	Special care in water sports, martial arts, weightlifting
17	Adenotomy	Absence of reactive phenomena, restoration of nasal breathing	10-12	12-20	Also
18	Galvanocaustics, cryotherapy of palatine tonsils	Lack of reactive phenomena in the pharynx	5-7	10-12	Also
19	Lancing an abscess nasal septum	Absence of inflammation in the nasal septum	7-8	10-14	When practicing boxing, wrestling, basketball, the terms are lengthened
20	Treatment of uncomplicated nasal injuries	Also	2-4	2-4	—
21	Resection nasal septum	Lack of reactive phenomena	5-7	10-12	Suspend from boxing, wrestling, basketball, the terms are lengthened
22	Radical surgery on the maxillary cavity	Lack of reactive phenomena, complete healing of the postoperative wound	14-18	20-25	Suspended from water and winter sports
23	Radical frontal sinus surgery	Also	Also	Also	Suspend from sports for one year. Further, depending on the state. Winter and aquatic species sports.
24	Radical temporal bone surgery	Also	Also	Also	Also