Spinal injury: symptoms, treatment, rehabilitation

The goals of rehabilitation of patients with diseases and injuries of the spine - why is it so important?

The success of rehabilitation treatment and rehabilitation after damage to the spine and spinal cord as a result of illness or injury depends on many factors , these are:

1. The severity of the disease or damage to the spine and spinal cord.
2. The amount of time that has passed since the illness or injury.
3. Patient's age.
4. Correctly chosen and timely treatment.
5. Other health factors, namely the presence of chronic diseases, metabolic status, and excess weight.
6. Bad habits and lifestyle of the patient.

Compliance with all points of the rehabilitation program prescribed by the doctor for many months and years.

The main danger that exists after injuries and diseases of the spine and spinal cord is paralysis of varying degrees and the associated disability of the patient.

Complications and consequences of pathology of the spine and spinal cord that require prevention and urgent treatment:

1. Wound sepsis.
2. Bedsores.
3. Infections of the urinary organs.
4. Pneumonia.
5. Deep vein thrombosis - and, as a terrible complication, pulmonary embolism.
6. Spastic syndrome.

The rehabilitation program, which should begin when the patient’s condition has stabilized and the threat to life has passed, is drawn up for each individual and must be comprehensive. Various types of rehabilitation programs can be implemented both in an inpatient and outpatient setting.

Consequences of spinal pathology and trauma for the patient at the psychological level:

• Mood swings, tearfulness.
• Loss of appetite.
• Insomnia.
• Irritability, frequent aggression.
• Anxiety, depression.
• Low self-esteem, “lost” in life.

Goals of rehabilitation of patients with diseases and injuries of the spine and spinal cord

• The maximum possible restoration of motor function of the patient’s limbs and body.
• Performing self-care.
• Improving the patient’s quality of life by adapting to all living conditions under current health circumstances.
• Psychological and physical adaptation to one's limitations.
• Socialization of the patient.
• Prevention of deeper disability of the patient.
• Return of the opportunity to work.
• Identification and treatment of complications of injury or disease of the spine and spinal cord.

After rehabilitation, the patient, even with residual symptoms of spinal cord dysfunction, must adapt to his normal life as comfortably as possible.

Specialists involved in the rehabilitation of patients with spinal pathologies and injuries:

1. Chiropractor.
2. Exercise therapy specialist.
3. Physiotherapist.
4. Neurologist, neuropathologist.
5. Psychologist.
6. The rehabilitation process is controlled by the attending physician.

Corsets

An orthopedic corset for a compression fracture of the spine is a special device that can be used to ensure the correct position of the spinal column. The corset helps distribute the load on the spine evenly and the rehabilitation process goes faster.

There are two large groups of corsets, which include:

• corrective – they correct spinal curvatures;
• supporting – help securely fix the spinal column.

According to the degree of rigidity, there are the following types:

• Semi-rigid - help eliminate pain, are used for preventive purposes, and relieve local stress from the spine. Some models can even have a massage and warming effect.
• Hard – designed for fusion of bones. Such corsets guarantee complete relaxation and removal of stress from certain areas of the spine, which plays an important role in compression fractures. Typically, corsets contain from 2 to 6 stiffening ribs, depending on the degree of fixation needed.

When choosing a corset, you should consider several nuances:

• Belt size . It is selected individually, especially when choosing for children or if you have a non-standard figure, tall height or excess weight.
• Material. Now corsets are made from two materials - plaster and metal-plastic. The second is less heavy and more aesthetically pleasing, easier to use. Although from a medical point of view they act approximately the same.
• Individual characteristics - for example, allergies to the material.

A corset can only be selected by a doctor, since independent actions in this matter will lead to hernias, swelling, muscle spasms and severe pain. There may also be contraindications to wearing a corset:

• some chronic diseases;
• mental illness;
• heart failure;
• pregnancy;
• skin diseases.

The effect of the corset on the spine is the manifestation of the following therapeutic effects:

• since the bones of the vertebral sections are in an immobilized normal state, they get used to this position and remain so for a long time;
• since the heaviness of the back is transferred to the corset, the back muscles become lighter;
• the back warms up due to active blood flow;
• the pain goes away, as spasms of the back muscles disappear, and the nerve fibers are not pinched by the bones that have been displaced due to the fracture;
• blood flow increases, which affects the supply of tissues with nutrients and oxygen.

If you have a spinal fracture, you should wear a corset for at least 4 months, and if complications arise, this can last for several years. The corset is worn only over underwear to avoid discomfort.

The daily regimen for wearing the corset is determined by the doctor - some patients need to wear it for 4-6 hours, taking breaks of 15 minutes, others almost around the clock - from 16 to 18 hours. You can't sleep in a corset.

When choosing a corset, you should understand that its cost will be rather high and even the prices of the most budget options will start from 15 thousand rubles. The following factors affect the cost:

• Material . Synthetic material is more expensive, but it has more advantages, as it allows the skin to breathe.
• Manufacturer company . Large brands always cost more, due to their popularity and good reviews. If these prices seem too high to you, turn your attention to a lesser-known company that also has good reviews.
• Individual order . If the standard shape of the corset does not suit the patient, then it needs to be made separately, which naturally increases the cost.
• Complexity of the fracture . In some cases, the patient needs to select a simplified version of the corset or, on the contrary, add stiffeners. Thus, making changes to the corset configuration will cost more.

Three groups of patients with spinal injury or pathology for choosing a rehabilitation program

Clinically, there are three groups of patients who have suffered diseases or injuries of the spine and spinal cord, which differ in the severity of damage and consequences:

1. Patients with mild damage to the spinal cord , in which its functions are not impaired, or almost not impaired.
2. Patients with pathology, moderate or severe injury to the spine and spinal cord, localized in the lumbar region or lower thoracic vertebrae.
3. Patients with pathology, moderate or severe injury to the spine and spinal cord , localized in the area of ​​the cervical spine or upper thoracic vertebrae.

Depending on whether each patient belongs to one of these groups, he is assigned a rehabilitation program:

1. For patients from group 1, rehabilitation has the goals of completely restoring all functions of the damaged spinal cord and spine, stabilizing the spinal column, strengthening the muscular corset around the spine, eliminating pain and restoring full motor activity, returning to work capacity. The main methods of rehabilitation of the 1st group of patients are physical therapy, physiotherapy, massage, balneotherapy. In terms of terms, rehabilitation of these patients can take a period from 1 month to 6-8 months.
2. In patients of group 2, rehabilitation is designed to ensure the maximum possible restoration of the functions of the spine and spinal cord. People must be independent in everyday life, have the skills and abilities to take care of themselves in everyday life, and control the processes of urination and defecation. Patients from the second group, in the process of social rehabilitation, may be able to drive a car, return to their previous job, or learn a new profession. Rehabilitation methods include physical therapy, massage, physiotherapy, acupuncture, as well as special measures that are aimed at restoring the function of urination and defecation. In terms of terms, the rehabilitation program for this group of patients takes a period of 10-12 months or more.
3. For patients of group 3 with severe lesions of the spine and spinal cord , rehabilitation aims to restore partial self-care skills, as well as gradually restore lost reflexes, muscle tone, and sensitivity. The complex of rehabilitation measures for such patients includes physical therapy and massage, the use of various technical means of rehabilitation and special equipment. The period of the rehabilitation program for patients in this group can range from 1.5-2 years or more.

Exercise therapy for the spine

Therapeutic exercise perfectly helps to restore the muscles of the back and chest, which have time to atrophy during the period while a person is in a supine position. Exercise therapy also activates metabolic processes, accelerates bone tissue regeneration, and restores the nervous system.

The use of physical education helps prevent the development of the following complications:

• blood clot formation;
• tissue necrosis;
• digestive problems;
• development of neuropsychiatric or general asthenic syndrome.

At the very beginning, physical education helps maintain tone, and only later you can move on to building muscle mass.

Exercise therapy is prescribed in 85% of cases of injury, since it is almost the main component of the rehabilitation process. It is allowed to begin if a person has noted the following improvements in his condition:

• normalization of body temperature;
• the appearance of positive results of drug therapy;
• all vertebrae are compared, and casts, wires and other elements are removed.

Stages of exercise therapy

There are 4 stages of physical therapy that are used for spinal fractures.

First stage

Physical education in the first 7-10 days makes it possible to increase the patient’s vitality, improve the functioning of the cardiovascular and respiratory systems, and prevent loss of muscle endurance.

When carrying out exercise therapy, breathing and general developmental exercises are used, in which small and medium muscle groups, as well as joints, take part.

All movements should be performed lightly and alternately, since excessive muscle tension can lead to pain. You can lift your pelvis by focusing on your shoulder blades and feet. Classes are conducted individually and their duration should not exceed 15 minutes.

Second phase

The second stage helps to normalize the activity of internal organs and systems, as well as improve blood circulation in the damaged area, as this will have a positive effect on the recovery process and strengthens the muscles of the torso, pelvic and shoulder girdle.

A muscular corset is developed, exercises prepare a person for the subsequent expansion of motor activity. Exercises are carefully selected, the number of their repetitions is gradually increased, which allows for an increase in the total load.

After 2-3 weeks, the patient may be allowed to roll over onto his stomach. The patient must perform static and dynamic exercises that involve the arms, abs and back muscles.

To create the best conditions for correcting spinal deformities and strengthening the back muscles, patients should perform extension exercises.

Third stage

The third stage should help strengthen the muscles of the limbs, torso, and pelvic floor, and affect the coordination of movements and mobility of the spine. To increase physical activity, it is recommended to increase the duration and density of exercise, adding exercises with weights, resistance and isometric muscle tension to the complex.

A smooth transition to axial loads on the spine occurs due to the transition to exercises with the starting positions of “kneeling” and “standing on all fours”. The bed should be lowered during general developmental and special exercises.

Fourth stage

A set of exercises at the 4th stage develops the muscular system, walking skills and helps to form correct posture. It is important to increase the mobility of the spine to the state in which it was before the injury, to strengthen the muscular system so that you can perform any movements.

The exercises are performed lying down and standing, all this happens in the hospital, at the slightest manifestation of pain, the exercises should be stopped, after which the doctor should examine the patient and adjust the program.

Contraindications to physical therapy

Sometimes it is possible that the use of physical therapy needs to be postponed. This can happen due to the following points:

• the general condition of the patient is very serious;
• the temperature has risen;
• impaired sensitivity and motor activity in the limbs;
• constant pain that becomes stronger after performing the exercise;
• changes in blood pressure;
• weakness after performing the complex;
• intestinal diseases.

Social rehabilitation of a patient after injuries or diseases of the spine and spinal cord

• Acquisition of new skills by patients in everyday life.
• Studying and developing your abilities in new conditions.
• Formation of hobbies and hobbies that can become the patient’s leisure time.
• Adaptation to the social and emotional consequences caused by illness or injury.
• Skills that need to be restored first during the rehabilitation process:
• Using the toilet, caring for the bladder, urinary catheter independently.
• Control over the processes of urination and defecation.
• Self-care - eating, dressing, washing, brushing teeth, cutting nails, combing, bathing, etc.
• Motor skills - walking, performing prescribed exercises and gymnastics, self-massage, driving a stroller.

What procedures can be performed at home after a spinal fracture?

The following procedures can be performed at home:

• exercise therapy;
• Kinesiotherapy;
• Mechanotherapy;
• Massage;
• Certain types of physiotherapy (myostimulation, magnetic therapy, phototherapy);
• Occupational therapy;
• Classes with a psychologist;
• Consultations with specialists (surgeon, urologist, neurologist, rehabilitation specialist).

Occupational therapy

Kinesiotherapy

Photodynamic therapy (PDT)

Myostimulation (electrical stimulation)

The presence of bedsores, epicystostomy, catheter, tracheostomy is not a contraindication for rehabilitation at home.

Compression fracture of the lumbar vertebrae

A compression fracture of the spine occurs as a result of intense pressure (compression) on the vertebrae. There are stable and unstable compression fractures of the spine. With a stable fracture, only the anterior or posterior part of the vertebra is damaged. After an injury, it does not shift, and the spinal column remains stable. With an unstable fracture, both the posterior and anterior parts of the vertebra are affected, which can lead to its displacement.

A compression fracture of the spine occurs as a result of a road traffic accident, a fall from a height, or a jump. Quite often the lumbar spine suffers. It has 5 vertebrae, which can be damaged singly or multiple times. A comminuted fracture of the spine is the most dangerous because in this case, parts of the bone can move forward and damage the spinal cord.

Provoking factors for the occurrence of a lumbar spine fracture are various diseases of the musculoskeletal system (osteochondrosis, radiculitis, osteoporosis). In the presence of degenerative-dystrophic changes, bone tissue loses normal strength and undergoes destruction. In some cases, a spinal fracture develops gradually (the bone tissue of the vertebra is destroyed) and the patient does not consult a doctor for a long period of time, since the clinical manifestations are weak. This is the danger of degenerative-dystrophic pathologies: their treatment begins in the later stages, when it is quite difficult to cure a person.

When a fracture occurs in the lumbar spine, the following symptoms may occur:

• Severe sharp pain;
• Numbness of the lower body;
• Impaired motor function of the lower extremities;
• Intestinal dysfunction (after a fracture, patients may develop paralytic intestinal obstruction, when there is no bowel movement, the abdomen becomes very painfully distended, nausea and vomiting appear);
• Paralysis of the lower body.

Rehabilitation after a lumbar spine fracture requires a lot of effort and time. The duration and intensity of rehabilitation will depend on the extent of the spinal injury. For full recovery, more than one course of rehabilitation may be required.

Nutrition during the recovery period

During rehabilitation after a compression fracture of the spine, a balanced diet is necessary, especially for older people. Experts recommend taking calcium to strengthen bones. You should also include phosphorus, vitamins D, C and B in your diet. You should eat meals in small portions.

The diet must include meat, eggs, jelly, jellied meat and fish. It is also necessary to consume dairy products, legumes, almonds, lentils, fresh berries and fruits. It is necessary to exclude fatty foods, alcohol, coffee, soda and chocolate.

Application of massage

The main purpose of massage during the rehabilitation period is to normalize metabolic processes and blood flow. It is used as an addition to therapeutic exercises.

The massage includes transverse and longitudinal stroking, light kneading and working with the chest. The first two sessions are conducted on a treatment couch, then the patient visits a chiropractor’s office. Massage therapists use all known techniques; the duration of the session is fifteen minutes.

Diagnostics

When the victim is taken to the hospital, doctors will conduct a physical examination and a complete neurological examination to determine the nature and location of the injury.

Based on the examination data, the patient is prescribed imaging methods that make it possible to determine morphological changes in tissues after injury.

Radiography -

allows you to diagnose fractures and dislocation of the vertebrae.

CT

– this research method is necessary for better visualization of both bone and soft tissues that are damaged during spinal trauma. In addition, CT is a more preferable diagnostic method when the patient’s condition is critical and it is necessary to quickly determine the cause of the condition and prescribe emergency therapy.

MRI.

This method is useful for identifying signs of spinal cord injury, hemorrhages and other morphological changes in soft tissues.

EMG (ENMG) -

allow you to determine nerve damage and the level of damage.

ECG, ultrasound, laboratory methods

studies are prescribed to exclude other consequences of injuries, especially when it comes to combined injuries resulting from accidents/

Densitometry -

necessary if osteoporosis is suspected.

Prices

Based on the results of the consultation, diagnosis and/or treatment will be prescribed.
*Prices in different regions may vary; current information on the cost of services can be obtained from the center manager.