Diseases of the spine, in particular of the vertebrae and intervertebral discs, are becoming epidemic, yielding in frequency only to colds..

This problem attracts close attention of physicians and rehabilitation specialists..

In other words, diseases of the spine (for example, osteochondrosis) are diseases of the century, which indicates socially significant changes in the life of a modern person..

Impact on the spine.

A sedentary, sedentary lifestyle, age, abundant nutrition, overweight determine diseases of the vertebrae associated with degenerative changes in the vertebrae themselves and the surrounding soft tissues.. Of all the muscles, only the muscles of the trunk and neck carry a constant load, which, with their tension, provide everyday and industrial postures of a person..

With muscle fatigue, the structures of the spine take on the load, therefore, with a constantly ongoing load on the spine, degenerative changes develop in it, primarily in the intervertebral discs. In clinical practice, the symptoms of spinal disease are manifested by a certain syndrome, i.e.. a group of symptoms associated with the disease.

In order to master the principles of diagnosis, treatment and prevention, it is necessary to know the anatomical, biomechanical and functional characteristics of the spinal column, adjacent muscles and ligaments, as well as the characteristics of blood supply..

The spinal column performs supporting, protective, shock-absorbing and motor functions.. The size of the vertebral bodies increases from the cervical to the sacral. In the thoracic region, 12 pairs of ribs are attached to the transverse processes, in the lumbar region - the diaphragm and mesentery of the intestine..

The vertebra has 7 processes (spinous, 2 transverse and 4 paired articular processes). In the cervical region in the transverse processes there are openings for the vertebral artery passing into the cranial cavity, which is very important for the blood supply to the spinal cord and brain.

On the arcs at the places of attachment to the bodies of the vertebrae there are notches. Adjacent vertebrae, in contact, form intervertebral foramens through which the spinal nerves pass.. The space between the arches is filled with strong elastic yellow ligaments.

Along the front and back sides of the vertebral bodies, the anterior and posterior longitudinal ligaments run along the entire length of the spinal column, limiting flexion and extension of the spine. Protecting the spinal cord, the spine also performs a protective function. Between the bodies and the arches is the spinal canal. It contains the spinal cord, its membranes, roots and blood vessels.

The spine performs the function of shock absorption, protecting the central nervous system from microtrauma due to muscle tension, physiological curvature, intervertebral discs, joint spaces.

The intervertebral disc consists of the nucleus pulposus and the fibrous ring surrounding it.. In the center of the nucleus there is a cavity containing a synovial fluid..

Discs connect the vertebral bodies to each other in a single column, increase intervertebral mobility. The disc has an " It is hydrophilic, able to absorb moisture and can double in size.. Disks in different departments experience different loads.

The load depends on the " In the cervical and lumbar regions, the height of the discs is maximum due to the high mobility.

There are about 50 intervertebral joints in the spine, which, together with the musculo-ligamentous apparatus, provide motor function.. In the intervertebral joints, movements are carried out relative to three axes: transverse (flexion and extension), sagittal (tilts to the right, left), vertical (turns to the right, left, circular movements).

Distinguish between passive and active parts of the spine. The passive part - vertebrae, discs, ligaments, intervertebral joints, which perform supporting, protective and cushioning functions. The active part is the muscles of the neck of the body, with the help of which the elements of the passive part are compressed and stretched..

Muscle Functions.

Muscle functions are very complex. Muscles are fixators of the intervertebral joints to create a fixed support for the working muscles, provide cushioning during shocks and tremors of the body, form and restrain the physiological curvature of the spine, maintain the vertical position of the body in standing and sitting positions (without support), ensure the movement of the spine.

The muscles of the neck and trunk perform two types of work: static and dynamic.. Static work provides fixation of the head and trunk, which is associated with fatigue of the central nervous system (muscles do not have rest).

With static work in tense muscles, blood circulation worsens. The dynamic work of the muscles of the neck and torso is associated with the movement of the head and torso in space..

It must be remembered that when leaning forward, the anterior sections of the discs are squeezed, and when leaning back, the rear. When tilted to the right, the right side of the disks is compressed, and the left side is stretched..

Since the nature of muscular work depends on the direction of movement and its pace, the movements of the neck and torso can be divided according to the degree of difficulty of their implementation.. In a standing and sitting position, the softest for the muscles are the movements of the head and torso around the vertical axis (turns to the right, to the left), since the moment of gravity of the head and torso during these movements is minimal, therefore, muscle tension is insignificant..

If the muscle tension is small, then the compression of the intervertebral joints and discs is minimal. The moment of gravity depends on the weight of the part of the body held by the tense muscles and the lever arm on which it acts..

The most difficult exercises for the muscles of the neck and trunk in a standing position are movements relative to the transverse axis (tilts forward and backward), especially backward tilts, due to overcoming the weight of the head and trunk with a large lever. At the same time, the compressive moment on the intervertebral joints and discs is maximum.

Very difficult for the muscular corset of the trunk and head is the starting position lying down.. With a slight rise of the head or torso above the area of \u200b\u200b\u200b\u200bsupport, the statically working muscles experience the greatest stress.. This creates the largest lever arm on which gravity acts..

A powerful extensor of the trunk is a muscle that straightens the spine. It is located deep, lies along the entire spine from the sacrum to the occipital bone and is divided into three parts.. One of them - the longest muscle - is attached to the transverse processes of the cervical vertebrae..

Movements in the cervical spine (tilting back and holding the head in a vertical position) are provided by the trapezius and patch muscles of the neck and head, as well as the erector of the spine. The tension of these muscles increases with small and fast hand movements, they also form cervical lordosis.. The forward tilt of the head is provided by the sternocleidomastoid and scalene muscles.. Rapid tilts of the head and neck occur with simultaneous contraction of the flexors and extensors of one side.

Movement in the lumbar spine and in the form of trunk extension is provided by the muscle that straightens the spine and the transverse spinous. The erector muscle consists of three muscles (iliocostal, longissimus and spinous), starts from the sacrum and stretches to the transverse processes in the cervical region.

This muscle holds the body in a vertical position, prevents falling forward under the influence of gravity.. The spine is subjected to a large load when the torso is extended while lifting weights.. Trunk flexion is provided by the rectus, external and internal oblique muscles of the abdomen, as well as the iliopsoas.. Trunk tilts occur with simultaneous contraction of the flexors and extensors of one side, turns - with simultaneous contraction of muscles with an oblique direction of the fibers.

Causes of the occurrence and development of diseases of the spine.

The causes of the occurrence and development of diseases of the structures of the spine are diverse.. There are several theories: muscular, endocrine, the theory of metabolic disorders, autoimmune. The reasons are still not entirely clear, however, in 85% of patients, the disease is associated with muscle overstrain, which is observed in people of many professions associated with prolonged fixation of working positions, the same type of hand movements, heavy physical labor, as well as in people exposed to vibration and.

Diseases of the vertebrae in the cervical region (osteochondrosis) occur due to " Long-term retention of a sitting posture also has a number of negative aspects: diaphragmatic breathing is difficult, the suction action of the chest is reduced (blood outflow through the system of the inferior vena cava is difficult as a result of stagnation of blood in the veins of the lower extremities, rectum, pelvic organs), the iliopsoas muscle is relaxed.

The smaller and faster the movements of the hands, the more pronounced the muscle tension.. It should also be noted that when the muscles of the shoulder girdle are tense, the excursion of the ribs is significantly limited, which sharply impairs pulmonary ventilation and accelerates the onset of fatigue.. Constant muscle tension impairs blood circulation in the muscles surrounding the spine, shoulder girdle, joints of the upper limbs.

Nutrition worsens, microtrauma occurs, especially at the points of attachment of muscles to bones. All this can cause professional osteochondrosis of the spine in persons of such professions as a typist, cashier, musician, telephone operator, seamstress, knitter, clerical worker, operator, dentist, etc.. The same muscle groups can overstrain in persons whose work is associated with a standing position (locksmith, painter, surgeon, sculptor, artist, etc.)..

When working while standing, the load on the lumbar region increases even more. The muscles of the lower back experience a particularly large load during work related to maintaining a posture and tilting, when carrying weights, throwing movements with hands..

In the future, as muscle fatigue increases, the stage of muscle compensation is replaced by recompensation, the trunk muscles weaken, lordosis smooths out and disappears, and the axial load on the intervertebral discs increases.. The cushioning function is reduced, which further increases the load on the vertebral bodies and discs.

All this contributes to the development of degenerative-dystrophic changes.. The degenerative process starts from the nucleus pulposus. It shrivels, loses moisture, central location and breaks up into separate fragments.. The fibrous ring becomes less elastic, softens, becomes thinner, cracks, tears, cracks appear in it.. Initially, cracks appear in the inner layer of the ring, where the nucleus penetrates, protruding the outer layer..

Degenerative changes in the disc lead to a decrease in its height, normal joint relationships are disturbed, displacements, subluxations, “looseness” of the vertebral segment appear, excessive mobility can lead to traumatization of the spinal cord and its roots.

A decrease in the depreciation function of the muscles increases the requirements for the supporting function of the spine. In this regard, along the edges of the vertebral bodies in different directions, bone growths (spurs) can form - osteophytes. In the posterolateral sections, they can compress the roots, the vertebral artery with its branches and cause clinical symptoms..

Most often, degenerative changes are observed in the lower cervical and lower lumbar regions..

Analyzing the causes and mechanisms of the development of the disease, three degrees of diseases of the structures of the spine can be distinguished:.

- changes in the active part of the motor apparatus (compensatory increase in muscle tone);

- Decrease in muscle tone and smoothness of lordosis;

- changes in the passive part of the motor apparatus (degenerative-dystrophic changes in the discs and vertebrae).

Thus, the clinical manifestations of changes depend on the location, degree of impairment, age, physical development.. Localization of diseases - cervical, thoracic and lumbar spine.

Neurological syndromes indicate late organic changes in the spine. Functional disorders: complaints of rapid fatigue of the muscles of the neck, shoulder girdle, back, lower back, acute pain caused by pinched nerves.

Danilov, V. Naboychenko medbe. en.