If the diagnosis is disc herniation: information, thoughts, conclusions

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Symptoms of lumbar disc herniation

The treatment program for intervertebral hernia includes manual massage, which must be performed by a qualified specialist. When developing treatment, the doctor takes into account the patient’s physical condition, existing medical indications and contraindications to the procedures.

The main symptom of the disease is displacement or damage to the fibrous membrane of the intervertebral cartilage, which leads to the leakage of a jelly-like secretion that fills the disc ring.

The pathological process develops gradually, in several stages:

• Prolapse. The intervertebral disc is displaced a short distance and falls into place without outside intervention.
• Protrusion. The displacement becomes more noticeable, but the disc is still located between the vertebrae, remaining within the limits of natural mobility.
• Extrusion and sequestration. The core of the disc bulges and comes out, gets pinched between the vertebrae and ruptures, causing the internal contents to spill out.

Symptoms depend on the stage of development of the disease and may include: deterioration of the reflexes of the lower extremities, numbness of the feet, lameness, burning sensation, hypertonicity of the back muscles, impaired bladder function, increased sweating, decreased potency in men.

Causes of hernia

• Progressive osteochondrosis of the lumbar spine.
• Poor posture, physical inactivity, weakness of the back muscles.
• Heredity.
• Previous spinal injuries.
• Prolonged hypothermia, sudden climate change.
• Increased physical activity.
• Sudden movements, sports activities with insufficient warming up of muscles, errors in position and pace of exercises.
• Prolonged stay in a sitting position.
• Exceeding normal body weight.

Indications for hernia treatment

Manual therapy is prescribed in the complex treatment of intervertebral hernia in the presence of the following medical indications:

• The occurrence of pain in the first stages of development of the pathological process, when the protrusion of the disc is still small, and restrictions on the mobility of the lumbar spine are observed.
• Significant pain in the final stages preceding a herniated disc.
• Disc displacement between the vertebrae, neurological pain, numbness and tingling of the limbs, spasms of the lower back muscles.
• Osteochondrosis of the lumbar spine.
• Acute pain, long lasting (several months).

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Read more about Karipazim and Karipain

Video about the treatment of disc herniation with Karipazim

Karipazim (Karipain), administered by electrophoresis, affects the hernia itself. It begins to gradually decrease and releases the nerve ending that it pinches, and the pain in the spine gradually disappears. To a lesser extent, the medicine affects the entire intervertebral disc. The drug enhances the regeneration of disc tissue, which restores its normal shape and its function as a shock absorber, while “rejuvenating” as it were. Karipazim also affects several neighboring intervertebral discs, restoring the entire spine. Read more about Karipazim and Karipain here

Advantages and disadvantages of this treatment method

The demand for manual therapy in the treatment of intervertebral hernia is due to a number of important advantages:

• Effective reduction of pain until it disappears completely.
• Restoring blood flow, enhancing tissue metabolism in the affected area.
• Reducing swelling, relieving muscle spasms in the area of ​​the spinal segment with an intervertebral hernia.

It is impossible to ensure complete recovery of a patient with a hernia using manual therapy methods, which requires the appointment of additional treatment procedures. This area of ​​medical practice can be used as an alternative to surgery. Treatment is effective provided that the pain is moderate in severity and the pathology does not progress beyond protrusion or slight protrusion of the nucleus.

On the day of your initial appointment with any doctor in our Neurology clinic, you can undergo manual therapy or massage with a 25% discount. This way you can form an objective opinion about the services of our clinic and the quality of work of our specialists. And if after this you decide to pay for the full course of further procedures, you will receive a 10% discount on the course of treatment.

Execution technique

First of all, with manual influence on the body, the doctor directs his actions to eliminate the functional blockade, that is, to relieve spasm, pain and restore mobility of the spine. After which the causative factors contributing to the appearance of the hernia are eliminated. During the therapy, the doctor increases muscle tone in the lumbar region.

How is manual manipulation performed?

On a note! Many people often confuse manual therapy with regular massage. But in reality, a massage therapist acts exclusively on the skin and affected muscles, and a chiropractor works on the skeletal system (individual vertebrae, cartilage tissue, joints, etc.).

To avoid unpleasant consequences or aggravation of injury, you must contact only a qualified specialist, so before starting treatment you need to make sure that the doctor has sufficient experience in this field and professional skills. As noted earlier, the duration of a manual course of therapy can be several years. But upon completion, patients are recommended to regularly perform therapeutic gymnastic exercises that will keep the muscle corset and spine in good shape.

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Only an experienced chiropractor is able to select a therapeutic course for a lumbar hernia in such a way as to avoid the need for surgery, which is considered a generally accepted radical method for this type of pathological condition.

How is manual therapy performed for a herniated disc?

Before starting work with an intervertebral hernia, the chiropractor examines the patient in order to localize the pathological protrusion. The examination may require CT or MRI procedures. The treatment program is drawn up taking into account the patient’s condition, the stage of development of the disease, and is aimed at both eliminating the main symptoms and preventing the development of complications.

If manual therapy is carried out in an acute period, the specialist chooses softer techniques to relieve the pain symptom. An improvement in the patient's condition is noted after the first procedure. The treatment uses shock-pulse techniques and decompression techniques, while the efforts applied by the therapist are increased gradually.

The actions of a manual therapy specialist are aimed at creating negative pressure in the spinal column, due to which the hernia will be reduced into place. Further procedures are necessary to prevent the consequences of pathological changes, restore the location of the nucleus of the intervertebral disc, reduce pain, and eliminate the causes that led to the development of a hernia (spinal osteochondrosis).

What it is?

The answer to the question: “what is manual therapy” can be answered very briefly: “This is treatment with your hands.”
The Latin word "manus" means hand, the Greek word "therapeia" means treatment. The essence of this treatment is a local dosed effect on the joints of the spine and limbs, muscles, ligaments, fascia in order to eliminate restrictions (blocks) that prevent their full functioning. It should be noted that the health of the nervous system largely depends on how well the musculoskeletal system works.

Manual therapy was introduced into the list of medical specialties by order of the Ministry of Health of the Russian Federation No. 365 dated December 10, 1997. It includes two main sections: diagnosis and manual treatment itself.

This medical direction combines the achievements of neurology, neurophysiology and orthopedics. Due to its effectiveness, it has become attractive to other medical specialties.

Manual therapy methods

Manual therapy demonstrates high effectiveness in the treatment of hernias that arise as a result of displacement of the vertebrae or intervertebral discs, deformation and dysfunction of the spinal column. Pressure on localized points and stretching of muscle fibers allows the structures to return to their natural position.

Achieving results is ensured by using several methods of manual therapy:

• Muscle-energy method.
  This technique is the mildest in impact, and therefore has a minimum of contraindications. The treatment eliminates sudden shocks, active movement, and is aimed at relaxing muscle fibers and smoothly stretching them to increase elasticity and increase blood circulation. This allows you to gently return the spinal segments to their place. The method is suitable for use in cases of severe pain.
• Musculofascial release.
  A mild impact most often does not cause any discomfort in the patient. Smooth and slow movements aimed at stretching and stretching muscle fibers gradually restore flexibility to the spinal column. The technique relieves swelling in tissues and relieves pain. Despite the softness of the impact, it has significant power.
• Pulse technology.
  A more traumatic technique should only be performed by a qualified specialist, as it can aggravate the displacement of the intervertebral disc or lead to pinched nerve fibers. Impulse effects involve sharp jolts, rapid tapping, and high intensity movements. The procedure is aimed at restoring the position of displaced vertebrae along the vertical axis. The force of impact is usually moderate, but the movements are sharp, so the accuracy of the actions performed is important.
• Craniosacral osteopathy.
  The technique covers all segments of the spinal column. Using techniques of stretching, pressing, twisting and turning, the doctor restores the correct position of the vertebrae along the entire length, correcting postural disorders. During treatment, the clearance between the vertebrae increases and the blood supply to tissues improves.

Manual techniques

1. Mobilization: positional, rhythmic, jolting (manipulation). The essence is to move the joints of the spine, limbs, muscles, ligaments, and fascia into a certain position, aimed at overcoming limited mobility.
2. Relaxation (relaxation): post-isometric, post-reciprocal. The essence is to achieve relaxation after short-term mild muscle tension.
3. Stretching. Used to stretch scars, shortened ligaments and muscles.
4. Pressure (pressure). This manual therapy technique is often called acupressure and is most effective for eliminating painful muscle tightness (trigger points) caused by spasm or fibrosis (scarring).

What are soft manual techniques?

These are almost all techniques with the exception of push mobilization, accompanied by a characteristic sound phenomenon perceived as a crunch or click. Some patients are afraid of this particular crunch. Although, to be fair, it should be said that push mobilization (manipulation) performed by an experienced specialist is quite gentle and completely painless, which cannot be said about some so-called “soft” manual techniques, for example, pressure.

Which manual techniques are preferable?

Almost all techniques of manual influence are aimed at eliminating disturbances in the functioning of the musculoskeletal system and normalizing the motor stereotype. What specific techniques are best used for the most effective treatment in each individual case must be decided by the doctor, based on the results of the studies and the individual characteristics of the patient.

To treat his patients, a chiropractor can also use instrumental methods of influence - fasciomyopuncture (puncture of the trigger point with a needle) and fasciomyotomy (microincision at the trigger point using a special scalpel with a narrow blade). Also, injections of various medications (local injections, blockades) can be performed into painful (trigger) points.

Localization of intervertebral hernia

The methods used in manual therapy for intervertebral herniation are selected based on the location of the disc protrusion.

• Cervical spine
  Treatment in this case is aimed at reducing the mobility of spinal structures using automobilization techniques. With one hand, the doctor tilts the patient's head forward, while with the other he holds the chin. The patient slowly turns his head, shaking it slightly. When performing the procedure, it is important to take into account contraindications: manipulation of the neck in the later stages of the disease is excluded; Do not make sudden movements or twisting; If the affected area is painful, massage is not performed.
• Thoracic department.
  This pathology is characterized by acute pain in the chest area, which is similar to the symptoms of intercostal neuralgia. Manual treatment uses techniques of force on the processes of the vertebral segments and techniques for relaxing the muscles of the damaged area. The procedure is performed on the patient in a lying or sitting position; in addition, triangular prisms can be used, which are inserted between the vertebrae, after which tapping is performed with a hammer. This allows you to remove compression from the disk. A thoracic hernia is treated using transverse massage and stretching of the muscle fibers.
• Lumbar region.
  Manual therapy for intervertebral hernia in this case involves the use of a wide range of techniques. This is due to the need for maximum relaxation of the muscles, which are the strongest in this area of ​​the spine. The main technique of influence is traction (traction). If the hernia is localized in the posterolateral part, then traction is performed by the legs with the patient lying on his stomach.

The manipulation is performed with caution, in a uniform rhythm of movements. After a break, stretching is repeated with greater force. When a crunching sound appears, we can talk about the positive dynamics of manual therapy. The procedures are carried out every other day; as the course of treatment is completed, the pain decreases and the crunching goes away.

For a hernia in the lumbar region, a directed push is used, which is necessary if softer techniques do not allow the vertebrae to return to their place. This technique can only be used by experienced specialists if there are no results from using more gentle methods.

Who has the legal right to heal with their hands?

At first, only neurologists and orthopedists-traumatologists who had undergone special postgraduate training (courses) had the right to practice manual therapy. Currently, there is a primary specialization in this area for all general practitioners. So, in order to use this type of treatment legally, you need to have a specialization either as a neurologist, or an orthopedic traumatologist, or a primary specialization in m/t. This is confirmed by a valid certificate.

Main complaints for which treatment by a chiropractor is indicated.

• Sudden acute pain in the lower back (lumbago) - lumbago;
• Chronic or subacute pain in the lower back (difficult to bend over, even more difficult to straighten up) - lumbodynia;
• Nagging pain in the leg, combined with pain or discomfort in the lower back - lumboischialgia;
• Pain in the back (shoulder blade area);
• Limitation of mobility, both in the spine itself and in large joints;
• Pain in the projection of the heart with a normal cardiogram;
• Pain in the neck, often radiating to the arm or head;
• Elbow pain;
• Pain in the shoulder joint (the arm rises with pain and does not rise completely);
• Frequent headaches, dizziness, tinnitus;
• Poor concentration, memory impairment;
• Numbness of fingers or toes;
• Pain in the coccyx - coccydynia;
• Aching pain in the knee (usually the lateral surfaces);
• Pain in the hip or buttock area.

Most common reason for calls

The most common cause of the above complaints is spinal osteochondrosis with the presence of hernias and protrusions of intervertebral discs! And these are the situations when correction of the spine is needed, and the sooner the better!

Results of manual hernia treatment

• Treatment involves performing procedures to restore the functionality of the spine, thereby eliminating the underlying cause of the disease.
• With a spinal hernia, compression of the nerve roots and narrowing of the space between the vertebrae is observed. The use of manual therapy methods can reduce compression of the structures of the spinal column, which reduces pain in the affected area and leads to remission of the disease.
• The pathological process of destruction of the intervertebral disc is triggered as a result of impaired blood circulation and metabolism in the lumbar region. During a course of manual therapy, blood flow is completely restored along the entire length of the spinal column.
• When using medications and physical therapy, the symptoms of the disease are eliminated, but only biomechanical effects using manual therapy methods can free pinched vessels and nerves and improve the patient’s condition.

Intervertebral hernia is difficult to treat and often causes serious suffering to the patient. Manual therapy is one of the most effective treatments that can eliminate the need for surgery, restoring the natural functionality of the spine, eliminating pain and restoring freedom of movement. A full course of treatment allows you to achieve significant improvements; at the initial stage of the disease, the chances of a complete cure are high.

A course of manual therapy is carried out in combination with other procedures to enhance the effect of treatment. Depending on the diagnosis, this may be acupuncture, physiotherapy, osteopathy, etc. These procedures complement each other and can be completed in our center.

If the diagnosis is disc herniation: information, thoughts, conclusions

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• Home / If the diagnosis is disc herniation: information, thoughts, conclusions

INTERVIEW OF NEUROSURGEON, SPECIALIST IN TREATING THE SPINE WITH MINI-SURGICAL METHODS, SERGEY SARYCHEV (RE-CLINIC, MOSCOW) to a correspondent of the online publication med-news.ru

From the editor: according to statistics, half of the world's population has back problems, and each of us has experienced all the delights of neck or lower back pain at least once in our lives. Back pain has a wide variety of origins. But today we want to talk about one of the most common and insidious causes of spinal pain syndrome - a herniated disc. It is pain that is the first manifestation of a hernia, which makes a person begin to worry about his health. The pain can be constant or occur unexpectedly and inexplicably, for example, when sneezing or simple and habitual movement. Weakness in the legs and difficulty urinating may occur. Since people tend to love self-medication, they often do not turn to specialists, but instead begin taking analgesics on their own and without control. An advanced hernia leads to loss of performance, quickly depriving a person of the ability to walk normally. Modern medicine offers many options for salvation. We asked Candidate of Medical Sciences Sergei Leonidovich Sarychev about how to get rid of a hernia and become a healthy person, how to prevent serious consequences of the disease.

Sarychev Sergey Leonidovich (Re-Clinic, Moscow) - Candidate of Medical Sciences, neurosurgeon of the highest category, vertebrologist, author of more than 30 scientific works on neurosurgery, performed over 10,000 minimally invasive operations on the spine. Since 2011, chief surgeon of the department of vertebropathology of the international Russian-Israeli Center Re-Clinic (Moscow), leading specialist in the field of mini-surgical treatment of back diseases.

— Sergey Leonidovich, the first question: how to notice the signs of a hernia in time? When should a person sound the alarm?

A hernia manifests itself as pain in the spine. Alarming symptoms are increasing or sudden weakness in the legs and difficulty urinating. A hernia interferes with normal life; in order not to feel pain, you have to constantly control your movements and limit physical activity. Previously it was believed that hernias could only occur in old age. Now we see among our patients young people, starting from the age of 20. The nature of the occurrence of a hernia in older patients is associated with metabolic-dystrophic processes characteristic of osteochondrosis. We can say that a hernia in the elderly is a complicated course of osteochondrosis. At a young age, a hernia is provoked by incorrect posture, leading to scoliosis, that is, curvature of the spinal axis, extreme physical activity, heavy lifting and injury. When should you see a doctor? When the first pain occurs in the cervical or lumbar spine, weakness in the limbs, loss of sensitivity. However, there is no need to panic.

The hernia itself is not life threatening. Its danger is not in the pain it causes. The risks associated with a hernia lie in those neurological disorders that will inevitably arise when the nerve root is pressed against the vertebral bone for a sufficiently long time at the place where it leaves the spinal canal. The spinal root, like any tissue in the body, is nourished and lives thanks to the blood supply and discharge vessels, only very small ones. If the vessels are partially compressed and their lumen is reduced, then the nutrition of the root deteriorates and its gradual atrophy and dysfunction of the conduction of nerve impulses occur. If you ignore the first symptoms, start taking painkillers on your own, dampen the pain, or simply endure it, then within six months, sooner or later, the first signs of serious complications will inevitably appear. An underexamined patient may initially be misdiagnosed and given the wrong, inappropriate treatment. You must understand that for back pain you cannot limit yourself to consultation and treatment with a neurologist; a mandatory consultation with a neurosurgeon-vertebrologist is required. The main thing is not to waste time and not rely solely on drug treatment. Otherwise, you may miss the onset of neurological complications. Unfortunately, we see patients being treated endlessly by neurologists and physiotherapists, massage therapists, chiropractors, kinesiotherapists and other specialists. No conservative methods can force a herniated disc back into the disc. There are methods for minimally invasive removal of protrusions and hernias, and delaying the start of such mini-surgical treatment can be costly for health and lead to complications.

— Sergey Leonidovich, tell us about the possible complications of hernias if they were not detected in time or if they were not dealt with...

Complications develop at different rates. Most often, this happens gradually over time, from six months to several years. There are cases of rapid manifestation of signs of complications. First, patients experience pain in a specific part of the spine - cervical, thoracic or lumbosacral. They are associated with the pressure of an incipient hernia, which is called protrusion, on an area with a large number of pain receptors...

...then the outer fibrous ring of the disc ruptures and the protrusion turns into a hernia itself. Part of the disc falls out into the spinal canal, the hernia presses the nerve root against the vertebral bone, and a picture of severe radicular syndrome and radiculitis develops. In fact, at this stage, pain has four sources of origin - mechanical compression of the root, swelling of the root, aseptic, that is, non-microbial, inflammation of the root and reflex spasm of the local back muscles above the site of the lesion. Damage to the root itself begins to increase due to a decrease in the lumen of the vessels feeding it, as we discussed above. Movement disorders and numbness in certain areas of the body appear, most often in the upper or lower extremities, depending on the location of the hernia in the neck or lower back. If adequate treatment is not started in time, the blood supply to the spinal cord is disrupted, and an ischemic spinal stroke (i.e., local necrosis due to lack of blood flow) may occur.

— Did I understand correctly that a herniated disc goes through stages in its development? The first stage is an incipient hernia or protrusion, and what next?

— Indeed, the development of a hernia is a dynamic process that has its own stages or phases. Protrusion of the intervertebral disc is the initial phase of its degeneration and destruction. A protrusion is essentially a protrusion of the disc substance beyond its normal boundaries. Protrusion is associated with the formation of microcracks in the internal fibrous rings while the outer one remains intact. Through these cracks, the disc substance, under the influence of high intradiscal pressure, penetrates to the boundaries of the disc and forces the outer ring to bend outward and press the nerve root against the vertebral bone. Symptoms of protrusion, like hernia, are pain, impaired motor function, forced immobility and pelvic disorders, muscle spasm and numbness. With the progressive course of hernia formation, the next phase begins - the formation of a true hernia. It is marked by a rupture of the outer fibrous ring. The symptoms are still the same, but may be even more pronounced. And finally, a complete separation of the hernia from the main “mother” substance of the disc is possible. This phase is called disc sequestration, and the detached part of the disc itself is called sequestration. At each stage or phase of hernia formation, the neurosurgeon decides on the use of one or another treatment method - from minimally invasive for protrusions, small and medium hernias to open major surgery when removing a large hernia or sequestrum.

— And yet, what should a person do if the diagnosis of “herniated intervertebral disc” is confirmed?

— First of all, if there is a reasonable assumption that back pain is associated with a problem of the spine, and not the internal organs, I would advise you to contact a neurologist and get a referral for an MRI scan of the painful area.

If the radiologist’s report mentions the presence of spinal pathology, such as protrusion, hernia, stenosis, vertebral fracture, spondyloarthrosis or other abnormalities, then you need to go to an appointment with a neurosurgeon-vertebrologist.

You can immediately take an MRI, without a referral from a neurologist, now it’s easy. In conclusion, everything will be written. You should come to a consultation with a vertebrologist with an MRI image or disc.

— And what can a vertebrologist, as a specialist in the treatment of the spine, offer in this case?

“You need to understand that there are many options to alleviate or temporarily remove pain. These are medications, physiotherapy, a course of massage, acupuncture, etc. All these methods, individually or together, can eliminate inflammation of the nerve root, its swelling, and reflex spasm of the spinal muscles over the site of the lesion. But they will never be able to eliminate the pressure of the hernia on the root, the mechanical component of the problem, and this is the cause of suffering. Therefore, a vertebrologist thinks in terms of radically ridding the patient of the cause of the disease. In the clinic where I operate, there is a large arsenal of minimally invasive, gentle treatment methods, which in terms of their sensitivity are close to conservative therapy, and in terms of their effectiveness in achieving the goal - to surgery. Minimally invasive microsurgery occupies an intermediate position between treatment in a clinic and treatment in a hospital, figuratively speaking, between pills and a scalpel.

This is a separate area of ​​spinal surgery, and it includes a whole range of high-tech mini-operations or manipulations. All of them are carried out using sophisticated equipment and consumables from the world's best manufacturers and require the doctor to have special knowledge and skills acquired during training in foreign clinics. I work in a specialized Spinal Center, which is fully equipped to perform the main types of minimally invasive procedures currently used in the world as an alternative to open “scalpel” surgery. In modern foreign clinics, open operations are used only for strict indications, when all possibilities of minimally invasive surgical treatment have been exhausted. There is a goal that the world vertebrosurgery declares - to cure the patient in one day, complete safety of treatment and the absence of complications. So, new technologies of micro-operations really make it possible to do this today.

— What minimally invasive methods are we talking about specifically and what do you use in your Center?

— I probably won’t dive into the world of technology and the biophysical foundations of micro-operations themselves.

If we just list the main or basic methods, then these are DISC-FX Nucleotomy, endoscopic transforamenal discectomy, laser thermodisplasty, cold plasma nucleoplasty, vertebroplasty, radiofrequency denervation, X-ray controlled blockades.

— What can you recommend to our readers? For those who do not want to waste precious time and want to get rid of pain as quickly as possible and return to normal life? What should these people do to avoid the serious consequences that you just talked about?

— Many people think that surgeons are just waiting for the opportunity to cut something off! For a spine surgeon, the main task is to establish the correct diagnosis, clarify the phase of the process, and understand the method of possible treatment. I prescribe and carry out not only minimally invasive or major surgical treatment. At our Center we have an excellent department of physiotherapy and rehabilitation medicine. If there are indications for conservative therapy and radical methods can wait, the patient is sent to this wonderful unit of ours. In 80% of patients who come to us, they receive conservative care in the absence of indications for any surgery, in 17% they receive minimally invasive procedures, and only in 3% they undergo open access treatment and major operations. Therefore, you should not be afraid of coming for a consultation; you must definitely decide on a diagnosis and treatment program for the future.

— Considering your many years of experience, is it possible to get a consultation with you?

— You can make an appointment without any problems. I would especially like to note that the Center hosts outstanding doctors from Israel. We regularly organize international consultations - consultations. Doctors of different specializations participate in them and a comprehensive treatment program is drawn up. We cooperate with:

Professor Ruven Gepstein (Herzliya) -

Doctor of Orthopedics, world-famous spinal surgeon, organizer of our clinic in 2011

and Dr. Alex Kalganov (Assuta) -

expert level specialist in the field of knee and hip replacement.

— Thank you, Sergey Leonidovich, for the interesting interview; it will be very useful for readers of our online resource!

Publications by Dr. Sergey Sarychev, Re-Clinic

• Back pain: you can’t tolerate it, treat it!
• Ask a vertebrologist: answers and advice

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Who will treat you?

In our center, we have assembled an excellent team of doctors who can not only professionally diagnose and formulate a course of treatment, but also carry out all the necessary procedures. You can get to know our doctors and the level of their work better in the video on the website and from the video reviews of our patients below.

Dremin Evgeniy Vitalievich

neurologist, reflexologist, chiropractor.
6 years of experience. more
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Contraindications to manual therapy for hernia

Absolute contraindications to manual therapy for intervertebral hernia are malignant neoplasms, infectious diseases in the acute stage, and the rehabilitation period after surgery. The possibility of treatment for relative contraindications is determined by the doctor individually for each patient.

The list of restrictions includes:

• Acute stage of osteochondrosis or intervertebral hernia.
• Anomalies in the development of the spinal column (congenital or acquired as a result of injury).
• Arthrosis in the last stages.
• Pregnancy.
• Hypermobility of the vertebrae in extreme form.

Before prescribing a course of manual therapy, the patient must undergo a series of examinations that will allow him to formulate an overall picture of the disease. For these purposes, ultrasound, MRI, X-ray, ECG, CT procedures are performed, a general blood test and densitometry are taken.