The deformity of ankylosing spondylitis has a certain regularity, that is, gradually from the lumbar, thoracic and cervical spine to the sacroiliac joint and hip flexion deformity, therefore, the principle of prevention and correction is to enhance the tension and strength of the corresponding extensor muscle groups on the basis of or at the same time as the comprehensive and balanced improvement of physical quality, with a view to counteracting the pathology of the spine and joints, so as to maintain the balance of the body.
Purpose, significance.
To maintain the active function of uninvolved cones and joints, to maintain the correct physiological posture, and to prevent the occurrence of spinal and joint deformities.
(1) To increase the mobility and flexibility of the spine and limb joints, and to prevent or delay the occurrence of deformities.
(2) Enhance the strength of muscles such as the lumbar back muscles and shoulder girdle muscles, bring into play the compensatory function of muscles and joints, improve the movement of affected joints, and alleviate the disease; prevent or reduce muscle atrophy due to disuse of limbs, maintain bone density and strength, and prevent osteoporosis
(3) Give full play to the compensatory function of the diaphragm and intercostal muscles on the thoracic respiratory function, while strengthening the training of thoracic breathing can prevent and improve the movement function of the cribriform joints.
(4) Cultivate patients’ awareness of scientific exercise, mobilize patients’ enthusiasm for treating diseases, and enhance patients’ confidence in disease recovery.
Key Tip.
The intensity of exercise during physical therapy rehabilitation is the key to the effectiveness of physical therapy, and it is important to control it effectively. Since the age of onset of ankylosing spondylitis is mostly young, the intensity of exercise can be controlled according to the following formula: (220-age) X 50-70%. Initial exercise can be low intensity (50%), after adaptation to gradually increase the intensity to the upper limit of the safe heart rate range (70%); if good health, hobby sports, you can also refer to the (exercise appropriate heart rate 170 – age) formula to control the intensity of exercise, or depending on their own situation. The exercise intensity should not cause fatigue, new pain and obvious soreness of joints and muscles, and should not affect daily life. Patients can also choose to use exercise programs according to their own preferences and physical conditions.
Exercise program selection
In view of the lesion characteristics of the disease, the commonly used exercise programs should include: maintaining the correct body position and posture; local functional exercise; low-intensity aerobic exercise; and overall physical fitness training.
Introduction of methods
1.Maintain the correct body position and physiological posture
Patients should always pay attention to maintaining correct posture and physiological position in daily life, work and study, and correcting bad habits is very important to prevent deformities. When standing and walking, try to lift the head, chest and abdomen, and train to stand with the back against the wall if necessary to maintain good body posture; sitting position is appropriate to use a straight-backed hard reclining chair, with the upper body straight and abdomen tightened, leaning backward as much as possible, with the hips and knees flexed at 90 degrees, avoiding sitting on a short bench or sofa to avoid bending over time; lying position requires sleeping on a hard bed, and regular supine position, and the patient needs to lie on a hard bed. Supine or prone position should be used as far as possible, avoiding lateral position, especially flexed leg lateral position, that is, avoiding cervical and thoracic vertebrae forward flexion position. In patients with severe pain, as the flexion position can reduce pain, it often puts the spine in a flexed position, which can lead to spinal hunchback deformity. A low pillow can help prevent the occurrence of thoracic kyphosis, and for patients with cervical spine involvement, a low pillow should be applied to prevent the reverse arch deformity of the cervical spine. The height of the pillow to maintain the normal forward arch of the cervical spine without increasing the upper thoracic vertebrae kyphosis degree. Generally 10cm high can be, the pillow as far as possible in the middle of the neck, the pillow as little as possible pillow. Every day should also use their own gravity in the morning, bedtime morning and evening to take a prone position for 10-20 minutes, should not be too long, so as not to affect breathing, most of the patients in the acute attack period need to bed rest, which requires particular attention; reading books, reading newspapers, writing, the line of sight should be parallel to the height of the books and newspapers, to avoid the cervical vertebrae too long back or forward tilt. Regardless of the above choices, patients should not use the same position and posture for a long time, should be appropriate to change position, and alternate with walking, physical activity, in order to maintain the normal physiological curvature of the spine, to prevent the formation of deformity accelerated by bad posture and position. The physiological curvature of the spine has disappeared or has been ankylosed, in addition to the above-mentioned, can also be placed in a pillow on the back when lying down to prevent or delay the formation of kyphosis.
Key Tip.
Postural therapy is a very important part of rehabilitation. Patients with ankylosing spondylitis should try to keep the spine in a straight position and ensure the presence of the normal physiological curvature of the spine, whether standing or sitting. Ankylosing spondylitis early lumbar back activity is limited, lumbar stiffness is mostly reversible, the maintenance of correct posture and position is very critical, it is often to prevent and delay deformity has a drug, physical therapy and other irreplaceable role, patients should pay attention to this. At the same time, the occurrence of the disease has a certain family genetic predisposition, and the onset of the disease is young and insidious, therefore, the development of good postural habits and early implementation of physical therapy are more significant for this group of people than for the general population. The correct posture now can avoid hunchback and deformity in the future, so that patients can remember and do it every moment.
2. Thoracic exercise and deep breathing exercise are necessary to prevent the lesion from reaching the chest and restricting breathing. Both are often performed simultaneously.
Methods.
1, standing position, chest up and abdomen, deep inhalation through the nasal cavity, both arms simultaneously abducted parallel to the shoulders, and then slowly exhale through the mouth, while both arms slowly lowered to the side of the body, restore. Repeat several times depending on the situation.
2, facing the corner of the wall, stand, abdomen and chest, head back as far as possible, two arms straight hands flat shoulder support on two walls, for 1 minute deep breathing; and then hands on two walls up to do wall climbing action. Repeat 5 times. Other special breathing exercises, upper limb stretching exercises, radio gymnastics chest expansion exercises, etc. also have the same effect. The exercise is not restricted by time, place and position, and can be performed anywhere, but at least once a day in the morning, in the afternoon and in the evening, if you can be persistent, the disease is very beneficial. Requirements: when practicing, deep breathing exercise is best to combine abdominal breathing and chest breathing alternately. Abdominal breathing is the diaphragm caused by the abdominal wall movement-based breathing exercise, deep breathing, the abdominal wall alternately bulge, deep sink, diaphragm lift amplitude increased, conducive to improving cardiopulmonary function, promote gastrointestinal motility; thoracic breathing is the intercostal muscles caused by the thoracic movement-based breathing exercise, deep breathing, thoracic alternate expansion, retraction, can effectively prevent and improve joint deformity and dysfunction of the rib cage. If the above can be well combined, is an ideal set of respiratory gymnastics, which is often surprisingly effective in the prevention and treatment of the disease.
3, spinal flexibility and hip mobility exercises
Mainly for the neck, chest, waist 3 parts of the front and back, stretching tilt, left and right lateral bending and greater than 45 degrees of rotation, as well as hip flexion, adduction and abduction exercises.
Methods.
1, take a standing position or sitting position, hands crossed waist or arms raised sideways, head and neck to the left side of the rotation, eyes to the left flat, upper body driven by the hip as slowly as possible to the right side of the body rotation, restore. Then practice in the opposite direction. Alternate between the left and right sides. Left and right sides each completed once for a group, each time to complete 5 groups.
2, take the standing position, both feet open with shoulder width, or take a sitting position, chest up, head and neck according to three activity axis, six directions of activity exercises, namely, forward flexion, back extension, left and right lateral flexion, left and right rotation, each action to do 5 times. Active movement requires maximum range of motion.
3, active bending, extension, side bending. Such as standing, straight-legged bending hands touching the ground; straight-legged sitting position, both hands to the direction of the toes; supine position, both arms or active up over the head, or passive upward stretching, or from the sides of the bed naturally down (can also hold a dumbbell in each hand); prone position, both arms naturally placed on the side of the body, the head, chest, limbs while lifting off the bed, only the abdomen on the bed, hold 5-10 minutes, restore; kneeling on the bed The head is bowed and the back is bowed, then relaxed and stepped waist and hips and head back, repeatedly alternating; standing or sitting position, both hands crossed waist, left and right alternately do waist and back side bending transport; hands crossed waist, waist and back against the wall, bending knees, bending hips slowly squatting, after slowly standing, repeat.
Requirements: the above exercises, 2 times / D, the order of their own arrangements, each action at least 5 times each time, the total practice time of 30-60 minutes, step by step, according to their ability.
Enhance the spine and hip mobility training
1.Flying swallow point water training
Prone position, both arms naturally placed on the side of the body, head and chest and limbs up at the same time, leaving the bed, only let the abdomen on the bed, in the “flying swallow pointing water”, hold 5-10s to return to the original position, rest 5-10s and then perform the above actions.
2.Four-point type
Supine double lower limbs are flexed on the bed, and then propped up with both hands, chest up, head lifted off the bed, the body is bow-shaped. Should adhere to daily exercise, the number of times should not be too much at the beginning, and then gradually increase, lasting 5-10s to return to the original position, rest 5-10s and then perform the above actions. Not less than 3 times a day, each time to do 30 to 50.
3, sports waist method
Sitting on the edge of the bed, or cross-legged or hanging legs on the ground, hands hot, press the waist eye, repeatedly rubbing 3min. change to upright posture, feet apart, the same width as the shoulders, bend the waist down, let two fingertips or palms as far as possible on the ground, together with a stoop, even do 21 times. Maintain an upright posture, arms crossed, twist the hips, slowly rotate the waist, first 21 times in a clockwise direction, and then 21 times in a counterclockwise direction. This method has the effect of warming the kidneys and strengthening the waist, can loosen the lumbar muscles, help treat ankylosing spondylitis lumbar stiffness.
The hands are raised to grasp the bar suspension, with their own weight for traction, can also perform pull-ups. Improve the coordination of the whole body, exercise limbs.
4.Water exercise
Carry out water medical gymnastics, make full use of the buoyancy of the water to relax the muscles and joints, reducing the stimulation of the affected joints, especially with the body in the water up and down, the impact of the water on the body also played a passive massage effect, its curative effect is quite popular. Patients can complete a variety of therapeutic movements in the water, such as chest expansion exercises, deep breathing exercises, spinal flexibility exercises, hip flexion, abduction, adduction exercises, etc. Patients in the water about 15 minutes of exercise in the back stiffness and pain can be relieved, less pain, good results. Swimming is the best and most comprehensive exercise for patients with ankylosing spondylitis, the disease is particularly suitable for swimming in the early stages, the conditions of swimming 1 / D can make the spine, limbs and cardiopulmonary function to get a full machine and balanced exercise.
5.Other rehabilitation exercise programs
Such as shoulder and back muscle stretching exercises, limb exercises, climbing exercises, rib wood gymnastics, etc. are ideal physical therapy methods, patients can choose their own under the guidance of a doctor, according to their own circumstances such as skills, special, physical conditions, etc. Radio exercise, taijiquan, health care gymnastics, walking, jogging, etc. are more and whole body aerobic exercises, which have positive effects on improving mood, increasing health and improving immunity of the body, and can be performed in different periods and stages of the disease. Some endurance exercise programs such as mountain climbing, swimming, long-distance jogging, etc. can help improve cardiopulmonary function and enhance muscle strength, and are suitable for young, physically fit early stage patients. When implementing the above exercises, attention should be paid to exercise control, so that it is easy for people, gradual and persistent.
Precautions.
1, the early stage of the disease should be based on preventive physical therapy, emphasizing active movement and correction of their own gravity, should avoid passive compulsory force, pay attention to the combination of whole-body exercise and local activities.
2, to adhere to the principle of gradual exercise, exercise intensity should not be excessive, joint activities should be carried out within its permissible range, to prevent excessive fatigue and prevent accidents.
3, most patients in the acute stage must rest in bed, physical therapy can therefore be carried out in bed, but the content and method must be agreed by the doctor.
4, because the disease is protracted, recovery is often a long process, therefore, the patient out of hospital long-term adherence to self-rehabilitation exercises is very critical.
The choice of rehabilitation treatment methods for different periods of ankylosing spondylitis
Early rehabilitation is the initial stage of ankylosing spondylitis, with pain in the low back and sacroiliac region, lumbosacral joint adhesions and morning stiffness, and normal or only mild inflammatory changes in sacroiliac joint X-rays. At this time, the patient is mainly in pain and has no difficulty in moving the spine. The aim of rehabilitation treatment is to maintain normal movement of the spine and other major joints in the proximal axis. In addition to postural therapy, sports therapy, heat therapy, hydrotherapy, and mud therapy can be used to relieve pain and eliminate inflammatory reactions once or twice a day.
In the middle stage of rehabilitation treatment, the inflammation has extended from the sacroiliac joint to the thoracic and lumbar segments of the spine, and can spread to the hip, knee, shoulder and other large joints. Joint pain, spinal movement is limited, but not yet completely ankylosed, treatment can still obtain a certain degree of flexibility of the spine. At this stage, in addition to continuing to apply methods to eliminate inflammation and relieve pain, sports therapy and postural therapy should be intensified, together with traction and passive exercise, 2 times/d. If necessary, orthoses should be added to prevent the occurrence of hunchback.
In the late stage of ankylosing spondylitis, the spine becomes fibrous and bony ankylosis. At this time, pain has mostly been reduced and various methods of pain relief are no longer important. There is still hope that patients who are not completely ankylosed and have a humped back can improve their symptoms through manipulative therapy, postural therapy, traction, passive exercise and orthotic correction, which should not be abandoned. The focus of rehabilitation treatment should be on enabling patients to take care of themselves in the future in order to enhance their ability to adapt to work, life and society.
Later rehabilitation treatment late patients with spinal ankylosis or ankylosis of hip, shoulder, or even knee need to undergo hunchback deformity correction surgery and artificial joint replacement for hip and knee.