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Neurophysiologic Substantiation of

Forming Pain Syndrome

Provoked by Dynamics

 

Topical Character

•Pain syndromes of  the lumbar spine are the most frequent patients’ complaints where the manual therapy cannot succeed. 
•Perhaps, it is connected with the fact that mobilization of functional blocks and extension of shortened muscles situated in the place of pain localization are performed in spite of factors provoking pain. 
•It explains the fact,   that contraindications to manual therapy application are growing in number but the frequency of pain muscle syndromes still goes up. 
•Aim of investigation:  Diagnostics of the pathogenesis of forming pain muscle syndromes provoked by dynamics.
•Material: 500 patients with pain muscle syndrome of different localization, for which the factor which provokes pain was hip extension.
 

Methods of investigation

Visual Diagnostics:
•     2.Interference  EMG
•     3. A vector evaluation of electromyograms
 

Visual criteria for the optimality of dynamics

•developed by us are based on correlation of the sequence of approaching each other margins of the area which form simple motion acts, constituents of the complex motion stereotype.
•Visual criteria of the normal motion pattern:
•monodirectionality of an exercised movement (only hip extension without abduction and rotation)
•Absence of synergism from the direction of adjacent regions

Interference  EMG

•. for assessing the sequence of involvement of all muscles participating in hip extension.
• In the norm, the muscle – agonist of the motor pattern “hip extension” – gluteus maximum is involved in the motion earlier than other muscular groups. 
 

A vector evaluation of electromyograms

•To correlate the bioelectric activity of a muscle with advanced inclusion into the movement and the bioelectric activity of a muscle agonist and/or synergist there was applied a vector evaluation of electromyograms developed by us.
• In this case the curves turning round the electromyograms were placed along the axis X and Y, and the resulting one – along the axis Z. Predomination of activity was evaluated according to the direction of displacement of the resulting curve from the axis Z to X or Y.

normal interrelationship between muscle groups 

•normal interrelationship between agonists, synergists and other muscle groups of the motion pattern under study. Under these conditions in all cases the coordinating electromyogram discovered anticipatory inclusion into the movement and prevailing activity of muscles-agonists and synergists with regard to other muscles
•The pictures preserve the same in many times repeats the movement
 

Visual and clinical diagnostics

•All patients had visual criteria for the atypical motion pattern the following ones were taken:
•change of the volume, path, speed,
•Polydirectionality of an exercised movement.
•Change of the movement direction and the pain localization depending on the localize muscle with a predominant of the activity
•the appearance of additional synkinesises in neighbor areas of spinal cord and extremities, differentiated in accord with the type of advanced inclusion of muscles 
 

The clinical- electromyography study

•of functional activity of a muscle–agonist in regard with other muscle groups of a disturbed movement (synergists, neutralizers, fixers, antagonists), their correlation to the standard and to each other allowed to find out that
•the bioelectric activity of a muscle agonist are accompanied by the change of its activation pattern (hypo excitability, change of the type of contractility)
• changes in the activation pattern of other muscle groups (hyper excitability, concentric type of contraction), especially of those which get into movement ahead of the agonist
 

Results

•76,6% patient with migration of the localize the pain syndrome had the prevailing significance is hypoexcitability of an agonist with subsequent formation of compensatory hyperactivity of other muscle groups.
•23, 4% patient with constant of the localize pain had prevailing significance is hyperactivity one of antagonist, synergist muscle groups with subsequent inhibition of the activity of agonist and other group muscle groups.
 

Conclusions:

•The clinic-instrumental investigation of a dynamic of the patients with pain muscle syndromes provoked by movements in an allowed to identify in the areas mentioned above the functional disorder of a motional act in the form of:
•change of muscle groups’ sequence of inclusion into the exercised movement
•of volume and directionality of the movement, the appearance of additional synkinesises in neighbor areas of spinal cord and extremities, differentiated in accord with the type of advanced inclusion of muscles
•It explains such a wide dislocation of pain muscle syndromes in the area of spinal cord and extremities remote not only from the source of hyperafferentation but in dynamically overloaded muscles.
•Pain syndromes are localized in dynamically overload muscles which are involved in the movement early than the agonist. Their shortening is the compensatory reaction. In connection with this their stretching has a short-term effect. In these cases the treatment should be directed to the rehabilitation of the agonist excitability. Thus, the obtained data make it possible to confirm that hypoexcitation of the agonist with the subsequent formation of compensatory hyperactivity of the other muscle groups plays a pivotal role in the formation of muscular imbalance with the hypo excited agonist
•It is known, that organic disorders of the nervous system manifest in the prolepses of functions (e.g. paresis,  plegia ). Their diagnostics is done in the place of lesion localization.
• Functional lesions muscular-skeletal system is accompany by development the biomechanical compensation of the decreased function. Namely, it is accompany by development the biomechanical overload and formed localize pain muscle syndromes in other vertebral regions and extremities (e.g. hip extension due to contractions in m. quadratus lumborum).
•That is why the manual diagnostics only biomechanical overloaded regions and the manual therapy in it not effective.
•Weekend and hypotonic muscles speaks the language visual asymmetry of movement.
•Dynamically overloaded muscle speaks the language of pain.
•To hear the language of pain in the hyper- excited muscle and understand the language of visual asymmetry of movement is the main task of the manual therapy.