Exercise therapy for hip dysplasia in children

Together with the usual treatment of hip dysplasia in young children, the use of exercise therapy and massage of the hip joint can significantly improve the progress of recovery. An integrated approach to the treatment of congenital hip dislocation, begun almost from the birth of the baby, helps to cope with the disease completely and so effectively that the child does not have problems with the hip joint in the future.

Gymnastics and therapeutic massage are the basis of therapeutic physical culture and complement each other for better medical therapy. Let's look at the basic recommendations for exercise therapy, its benefits and a set of exercises.

The benefits of gymnastics for dysplasia, its features

For hip dysplasia, positioning treatment is used. It includes:

Massage;
exercise therapy;
Wide swaddling;
Splinting.

These methods are used more often, given that they are quite effective. They help especially well when treatment is started early. Often, with mild dysplasia, one, or maximum two, courses of exercise therapy are used, which proves their effectiveness.

It is important to remember that until the child has learned to sit and walk, it is impossible to perform exercises such as “squatting”, “standing” and any others in an upright position. Additional stress can lead to further deformation of the hip joint. Exercise therapy here will be useless at best.

You can do physical therapy with a child with dysplasia at home. Then it is very easy to choose the right time when the child is fed and has slept well, which indicates his good health. This is important for infants. When conducting exercise therapy in a hospital, it is important to choose the same appropriate time.

It is better for the baby’s mother to entrust the first few sessions of gymnastics to a specialist, undergo instruction, and then repeat the complex at home.

For classes you need a hard surface (regular table, changing table or board). It is necessary to lay a waterproof (in case of unexpected “accidents”) or a simple diaper on it. The air temperature should be comfortable (about 21℃), and there should be no drafts in the room.

An adult's hands should be washed. They should not be cold for the child to be comfortable. Hand movements should be performed smoothly, without jerking. The child should not be in pain.

An orthopedist usually prescribes exercise therapy in a course of 10 to 15 gymnastics sessions. Additional courses after one and a half to two months are necessary to consolidate the results. At home, they can be carried out on an ongoing basis several times a day until complete recovery.

Principles of rehabilitation of patients with connective tissue dysplasia

An important condition for effective rehabilitation of patients with various nosological forms of connective tissue dysplasia (CTD) is the correct choice of medical means: non-drug, medicinal or surgical. Many years of experience in dispensary observation of families of patients with various variants of hereditary connective tissue diseases and CTD, analysis of literature data made it possible to formulate the basic principles of treatment for these patients:

Non-drug therapy (adequate regimen, diet, physical therapy, massage, physical and electrical treatment, psychotherapy, spa treatment, orthopedic correction, vocational guidance).
Diet therapy (use of food products enriched with protein, vitamins and microelements).
Drug symptomatic therapy (treatment of pain, improvement of venous blood flow, taking beta blockers, adaptogens, sedatives, hepatoprotectors, surgical treatment, etc.).
Pathogenetic therapy (stimulation of collagen formation, correction of disorders in the synthesis and catabolism of glycosaminoglycans, stabilization of mineral and vitamin metabolism, improvement of the bioenergetic state of the body).

An obligatory stage in the management of patients with CTD after a comprehensive examination and diagnosis is a competent conversation between the doctor and the patient before starting rehabilitation therapy. It is necessary to gain the trust of both the patient and his parents in terms of the possibility of significantly improving the quality of life and restoring lost adaptive skills. Experience shows that the doctor should not waste time on this first, extremely important conversation, on which the effectiveness of rehabilitation measures largely depends. It is important to correctly and in an accessible form explain to the sick teenager and his parents:

what is connective tissue dysplasia;
what is the role of genetic and environmental factors in its origin;
what changes in the body it can lead to;
what lifestyle should be followed;
how quickly the effect of the therapy occurs and how long it should be carried out;
how often should instrumental studies be carried out;
what are the possibilities of surgical and therapeutic correction;
what are the dangers of playing professional sports and dancing;
What are the restrictions in professional activities?

If necessary, consultation should be held on the issue of marriage and family, suitability for military service, etc. The purpose of this conversation is to instill the idea of the need for the patient’s active participation in treatment, prevention of complications, and identification of symptoms of disease progression. If possible, the patient should be convinced that the changes in connective tissue observed in him require a special lifestyle, the quality of which is largely determined by his efforts in the desire to help himself. It should be remembered that sufficient knowledge about the disease can help the patient look into the future without fear.

Next, we will allow ourselves to outline in more detail the basic principles of therapy for patients with DST.

Basic principles of non-drug therapy

Daily regime. In the absence of significant functional disorders of leading organs and systems, patients with CTD are shown a general regimen with the correct alternation of work (study) and rest. The exception is patients with osteogenesis imperfecta, who, in order to prevent fractures, need to lead a gentle lifestyle (wear corsets, use crutches, avoid trauma). Patients with osteoarthritis due to DST also require limiting the load on the affected joints. They are not recommended to run, jump, lift and carry heavy objects, squats, fast walking, especially over rough terrain, climbing mountains and walking up stairs. It is advisable to avoid a fixed position, such as prolonged sitting or standing in one position, which impairs blood flow to sore joints. If the joints of the upper extremities are affected, you should limit carrying heavy objects, manually pushing up heavy things, playing musical instruments, and typing on a hard keyboard. The rhythm of optimal motor activity for patients with osteoarthritis due to DST is a reasonable alternation of load (10–15 minutes) with periods of rest (5–10 minutes), during which the joint should be unloaded in a lying or sitting position. To restore blood circulation after exercise in the same positions, you should perform several movements in the joints (flexion, extension, bicycle).

Physical therapy is indicated for all patients with DST. Regular (3-4 times a week, 20-30 minutes) moderate physical training aimed at strengthening the muscles of the back, abdomen, and limbs is recommended. Exercises are carried out in a non-contact static-dynamic mode, in a supine position. Physical exercise should not increase the load on the ligamentous-articular apparatus and increase the mobility of the joints and spine. The method of physical therapy should definitely be discussed with a specialist. In this case, it is necessary to take into account the nature of the pathology, clinical, radiological, and biochemical criteria for damage to the musculoskeletal system. It is useful to prescribe sets of exercises performed while lying on your back or stomach. For most patients, hanging and spinal traction, types of contact sports, isometric training, weightlifting, and carrying large loads are contraindicated. Hydrotherapy and therapeutic swimming, which relieve static load on the spine, have a good effect.

Aerobic training of the cardiovascular system is recommended: dosed walking, skiing, traveling, hiking, jogging, comfortable cycling. Dosed physical activity on exercise machines and exercise bikes, badminton, table tennis, exercises with light dumbbells, and breathing exercises are useful. Systematic physical activity increases the adaptive capabilities of the cardiovascular system. However, if there are signs of its damage - myocardial dystrophy, cardiomyopathy, myxematous degeneration and significant prolapse of the valve leaflets, dilatation of the aortic root - excessive physical or mental stress, participation in any sports competitions is strictly prohibited. All patients with DST should not engage in professional sports and dancing, since excessive loads on functionally defective connective tissue will lead to an extremely rapid onset of its decompensation.

Therapeutic massage - relieves painful muscle spasms, improves blood supply, transmission of nerve impulses, trophism of the trunk muscles and joints. Recently, acupressure with a helium-neon laser beam, which has a biostimulating, analgesic, and sedative effect, has become widespread. Procedures are performed daily or at intervals of one or two days; It is advisable to undergo at least three courses of treatment (15–20 sessions) with an interval of one month. Underwater massage gives favorable results.

Physiotherapeutic treatment is used according to indications. Thus, with osteogenesis imperfecta, to accelerate the healing of fractures, with osteoporosis of various origins, electrophoresis of a 5% calcium chloride solution, 4% magnesium sulfate solution, 2% copper sulfate solution or 2% zinc sulfate solution is recommended on the collar area or locally. In case of vegetative-vascular dystonia syndrome of the vagotonic type, often accompanying DST, a 1% solution of caffeine sodium benzoate, ephedrine hydrochloride or mesatone is used - using the collar method or the ion reflex method according to Shcherbak. To stimulate the function of the adrenal cortex, drug electrophoresis with 1.5% etimizol and DMV is used on the area of the adrenal glands. To normalize vascular tone, water procedures are prescribed that provide “gymnastics” for blood vessels: general carbon dioxide, pine, hydrochloride, hydrogen sulfide and radon baths. At home, douches, rubdowns, contrast showers, salt-pine and foam baths are available. A very useful physiotherapeutic treatment method is a sauna (air temperature - 100 ° C, relative humidity - 10-12%, duration of stay - 30 minutes), course - 25 sessions over 3-4 months. Magnetic, inductive and laser therapy, electrophoresis with Dimexide (dimethyl sulfoxide), and brine are used quite widely to improve the nutrition of cartilage.

In order to soften dense connective tissue formations (for example, postoperative keloid scars), patients with DST undergo phonophoresis. For this purpose, use Collalysin (collagenase), 0.2% solution of hydrocortisone, water-soluble succinate, lidase; fibrinolysin. Electrophoresis using the 4-electrode method of ascorbic acid, sulfur, zinc, copper is widely used; chromotherapy (green, red matrix) according to the general method.

Psychotherapy . The lability of nervous processes inherent in patients with connective tissue pathology, feelings of anxiety and a tendency to affective states require mandatory psychological correction, because neurotic behavior and suspiciousness greatly influence their attitude to treatment and implementation of medical recommendations. The main goal of therapy is to develop a system of adequate attitudes and consolidate a new line of behavior in the patient’s family.

Sanatorium-resort treatment - allows for comprehensive rehabilitation, including the positive effects of therapeutic mud, hydrogen sulfide, radon, iodine-bromine baths, saunas, physiotherapy, massage and physical therapy exercises. It is especially effective if this treatment is carried out for at least three years in a row.

Orthopedic correction is carried out using special devices to reduce the load on the joints and spine. These include orthopedic shoes, instep supports, knee pads that can reduce knee joint laxity and cartilage trauma when walking, and elastic bandaging of hypermobile joints.

Surgical treatment of patients with DST is carried out strictly according to indications. Thus, in case of significant hemodynamic disturbances due to prolapse of the valve leaflets, massive aortic aneurysm, valve replacement and the changed portion of the aorta are performed. In cases of severe functional disorders of the cardiovascular and respiratory systems caused by severe deformation of the chest, thoracoplasty is performed. Progressive pain syndrome in patients with DST with severe grade III–IV scoliosis serves as an indication for surgical treatment. Lens subluxation, complicated by secondary glaucoma, retinal degeneration with the threat of retinal detachment and cataracts are absolute indications for surgical treatment (lens removal). Our practical experience shows that any surgical intervention in patients with pathology of connective tissue metabolism should be carried out only against the background of relative clinical and biochemical remission. After surgical treatment, patients should be under the supervision of specialists and receive, along with traditional therapy, drugs that improve connective tissue metabolism.

Lifestyle. Due to impaired DNA reparative ability, patients with DST The best place to live is the central belt. It is advisable to exclude stressors and sudden changes in professional activity. Weather-dependent patients should avoid professional and psycho-emotional overload on unfavorable days. It is important to prevent hypothermia of the upper and lower extremities. During the cold season, always wear gloves and warm socks. For women, especially when working standing, the use of compression hosiery (anti-varicose tights 50–70 denier) is recommended.

Professional guidance. Specialties associated with high physical and emotional stress, vibration, contact with chemicals and exposure to x-rays should be avoided.

Basic principles of diet therapy. Diet therapy for patients with connective tissue dysplasia is prescribed only after a preliminary examination by a gastroenterologist and (necessarily!) during a period of relative remission of chronic pathology of the gastrointestinal tract, which, according to our data, was observed in 81.6% of patients with DST. Protein-enriched foods are recommended. Additionally, meat, fish, squid, beans, nuts, protein and fatty acids, and foods containing essential amino acids are prescribed. Food products must be enriched with microelements, vitamins, and unsaturated fatty acids.

Patients without gastroenterological pathology are prescribed strong broths, jellied meat and fish dishes containing a significant amount of chondroitin sulfates several times a week. For the rest, it is advisable to take biologically active supplements (BAA) containing combined chondroprotectors 2-3 times a week. For children with excessive growth, food products (soybean, cottonseed oil, sunflower seeds, lard, pork fat, etc.) are recommended from an early age, as well as preparations with a high content of polyunsaturated fatty acids of the Omega class, which have an inhibitory effect on the secretion of somatotropic hormones. hormone.

Products containing B vitamins are shown - B1, B2, B3, B6, which normalize protein metabolism. A significant amount of vitamins of this group is contained in yeast, germs and shells of wheat, oats, buckwheat, peas, as well as bread made from wholemeal flour, liver, and kidneys.

Food products enriched with vitamin C (fresh rose hips, red peppers, black currants, Brussels sprouts, porcini mushrooms, citrus fruits, etc.) and vitamin E (sea buckthorn, spinach, parsley, leeks, chokeberries, peaches, etc.) are extremely important. , necessary for normal collagen synthesis and possessing antioxidant activity.

According to our data, the vast majority of children with connective tissue dysplasia have a decrease in the level of most macro- and microcollagen-specific bioelements. The most common deficiencies were silicon (100%), selenium (95.6%), potassium (83.5%); calcium (64.1%); copper (58.7%); manganese (53.8%), magnesium (47.8%) and iron (46.7%). All of them take an active part in the mineralization of bone tissue, the synthesis and maturation of collagen. In this regard, food enriched with macro- and microelements is recommended. An important point in diet therapy is maintaining optimal ratios in the diet between calcium and phosphorus (1:1.5), as well as calcium and magnesium (1:0.5), which, according to our data, is disturbed in patients with DST. An unbalanced diet can cause a negative balance of calcium and magnesium in the body and lead to even more severe metabolic disorders in the bones. The absorption of calcium is facilitated by the presence of lactose, proteins, and citric acid in food. This process is hampered by phytic acid, which is found in cereals, as well as oxalic acid, phosphates and various fats.

Principles of drug pathogenetic therapy

It is advisable to carry out pathogenetic drug therapy 1–2 times a year, depending on the patient’s condition; Course duration: 4 months.

Stimulation of collagen formation is carried out by prescribing drugs such as Piaskledin 300, Solcoseryl, L-lysine, L-proline, vitreous body in combination with cofactors for collagen synthesis - vitamins (C, E, group B) and microelements (Magnerot, Magne B6, zinc oxide , zinc sulfate, zinc aspartate, zincite, copper sulfate (Cuprum sulfate, 1% solution), zinc, selenium. Our studies revealed increased excretion of collagen breakdown indicators (hydroxyproline, pyrilinx D in daily urine, etc.) in 75% of examined patients with DST.

Chondroprotectors. The most studied are chondroitin sulfate and glucosamine sulfate. Over the past 20 years, dozens of controlled studies have been conducted to study the structure-modifying effects of these drugs. Their participation in the regulation of chondrocyte metabolism (increased synthesis of glycosaminoglycans and proteoglycans) has been proven; suppression of enzyme synthesis and increased resistance of chondrocytes to the effects of enzymes that damage articular cartilage; in the activation of anabolic processes of the cartilage matrix, etc. The drugs of choice are currently combined chondroprotectors (Arthra, Teraflex, Kondronova, Artroflex, etc.). We detected excessive secretion of glycosaminoglycans in daily urine in the majority (81.4%) of the examined patients with DST.

Stabilization of mineral metabolism . To improve the state of mineral metabolism in patients with DST, drugs are used that normalize phosphorus-calcium metabolism: vitamin D2, and, according to indications, its active forms: alfacalcidol (Alpha D3-Teva, Oksidevit), vitamin D3 BON, Bonviva, etc. Along with the above Above, various preparations of calcium, magnesium, and phosphorus are widely used to correct mineral metabolism. When treating with them, it is necessary to monitor the level of calcium, phosphorus in the blood or urine, as well as the activity of alkaline phosphatase in the blood at least once every 3 weeks. It is known that the need for calcium changes at different periods of a person’s life, therefore, when correcting mineral metabolism parameters, it is necessary to take into account the age-related daily need for calcium.

Correction of the bioenergetic state of the body is necessary due to the presence of secondary mitochondrial deficiency in patients with DST. In 80% of the children we examined, a secondary deficiency of total carnitine was detected. Improving the bioenergetic state of the body is facilitated by drugs containing phosphorus compounds: Dimephosphone, Phosphaden, Riboxin, Mildronate, Lecithin, Amber Elixir, Elcar, Carnitene, Coenzyme Q10, Riboflavin, Nicotinamide, etc.

Normalization of peroxidation processes is carried out by prescribing vitamins (C, A, E), Mexidol, citrus bioflavonoids, selenium, glutathione, polyunsaturated fatty acids.

Correction of free amino acid levels in blood serum

In patients with DST, as a rule, there is a decrease in the content of most nonessential and essential amino acids in the blood serum, most often due to impaired absorption through the gastrointestinal tract. Such secondary hypoaminoacidemia cannot but affect their general condition, contributing to a deterioration in the quality of life of patients. We have established a relationship between a decrease in the level of free proline, free leucine and isoleucine, an increase in free hydroxyproline in the blood serum and the severity of the clinical picture. Correction of the level of free amino acids in the blood is carried out through individual selection of diet, amino acid preparations or dietary supplements containing essential amino acids, as well as vitamins and microelements involved in their metabolism. Most often, in our experience, patients with pathologies of connective tissue metabolism require replacement therapy with lysine, proline, taurine, arginine, methionine and its derivatives, tyrosine and tryptophan. Amino acids are prescribed 30–60 minutes before meals. The duration of one course is 4–6 weeks. Repeated course - according to indications, at intervals of 6 months. Today, the doctor has a number of amino acid preparations at his disposal (Methioninum, Glutaminicum acidum, Glycinum, Dibikor and a number of biologically active food supplements.

Approximate treatment regimens for sick children with CTD

Depending on the severity of the clinical condition and the severity of biochemical disorders of connective tissue metabolism, it is recommended to carry out 1–2 courses of metabolite correction throughout the year. The duration of treatment is determined in each case individually, but on average it is 4 months with a break between courses of at least 2–2.5 months. If indicated, in the intervals between courses of drug therapy, physiotherapeutic procedures are performed and psychotherapy is carried out. Patients with DST need to constantly follow a regimen, diet, and engage in physical therapy.

I scheme

Combined chondroprotector in an age-related dose. Take with meals; drink plenty of water. Duration of treatment is 2–4 months.
L-proline. Dose for children aged 12 years and older: 500 mg; take 30 minutes before meals; frequency of administration - 1-2 times a day; duration - 1.5 months; according to indications, a complex of amino acids is prescribed (L-proline, L-lysine, L-leucine at the rate of 10–12 mg per kg of body weight, etc.); dosage frequency 1–2 times a day; duration - 2 months.
Vitamin and mineral complexes such as “Vitrum”, “; dose - depending on age; Duration of treatment: 1 month.

Note: indications for prescribing this treatment regimen are a variety of patient complaints, especially damage to the musculoskeletal system, increased excretion of glycosaminoglycans in daily urine and a decrease in the content of free amino acids in the blood serum.

II scheme

Combined chondroprotector in an age-related dose. Take with meals; drink plenty of water. Duration of treatment is 2–4 months.
Ascorbic acid (in the absence of oxaluria and a family history of urolithiasis) in the form of cocktails (with milk, yogurt, jelly, compote, etc.); dose - 0.5–1.0–2.0 g per day, depending on age; Duration of treatment: 3 weeks.
Amber elixir. Dose depending on age - 1-2 capsules 2 times a day (capsule contains 100 mg of succinic acid); Duration of treatment: 3 weeks.

Note: indications for the use of this regimen may include clinical and instrumental signs of damage to the musculoskeletal system, increased excretion of glycosaminoglycans in daily urine; normal levels of free proline and free lysine in blood serum.

III scheme

L-lysine. Dose for children aged 12 years and older: 500 mg; take 30 minutes before meals; frequency of administration - 1-2 times a day; according to indications - a complex of amino acids (L-proline, L-lysine, L-leucine), selected individually; frequency of administration - 1-2 times a day; duration - 2 months.
Vitamin E (preferably the natural form containing alpha-tocopherol or a mixture of tocopherols); dose for children aged 12 years and older and adults - from 400 to 800 IU per day; Duration of treatment: 3 weeks.

Note: the use of this treatment regimen is recommended if there are a variety of patient complaints; clinical and instrumental disorders of organs and systems, a decrease in the content of free amino acids in the blood serum and normal excretion of glycosaminoglycans in daily urine.

The use of the above schemes for individually selected and pathogenetically based correction of identified biochemical disorders in children with CTD is quite possible in an outpatient setting and practically does not require additional material and technical investments. Patients with DST require lifelong clinical observation, constant non-drug therapy and systematic courses of metabolic replacement correction.

T. I. Kadurina*, Doctor of Medical Sciences, Professor L. N. Abbakumova **, Associate Professor

*Medical Academy of Postgraduate Education, **St. Petersburg State Pediatric Medical Academy , St. Petersburg

Contact information for authors for correspondence

Preparing for gymnastics

Before the lessons themselves, the child needs to be prepared. Warming up will allow the main gymnastics course to be more effective .

First, they begin to massage the outer thighs, then the rest of the legs, including the ankle and feet themselves. The inner surface of the thighs near the genitals should not be touched. Second stage: lightly rub in a circle or with direct movements (without moving the skin or squeezing strongly) the most damaged joint.

Ultrasound diagnostics

This research method makes it possible to evaluate the cartilaginous structures that predominantly comprise the joint of a child in the first months of life, as well as muscle and connective tissue components. Ultrasound diagnostics makes it possible to conduct functional tests in real time. Additionally, dynamic monitoring can be carried out during the child’s treatment. The optimal time for conducting a screening study is the age of 4-6 weeks of life. The fact is that the hip joint is already, for the most part, formed.

A set of exercises for dysplasia

It is recommended to perform gymnastics using the following exercises:

The child is lying on his stomach. The baby's heels are taken in one hand, smoothly brought to the buttocks and straightened. The movements are reminiscent of a “frog”;
In the position on the stomach, the legs are alternately moved to the side (left-right). Do not bend your knees;
Same situation. The child's legs are bent alternately at the knee and hip joints. The exercise resembles the “frog”, but for one leg;
Bringing the heels to the buttocks in a prone position in order to encourage the child to crawl (imitating crawling by pushing);
Position "on your back". The child’s legs are spread apart without bending at the knee joint;
Position "on your back". Flexion of the hip and knee joints of one leg and its abduction alternately. Try to reach the surface with your knee;
"Open book" exercise. In the “supine” position, the child’s hip and knee joints are bent and at the same time moved apart to the maximum angle. Hold the position at the extreme point for a short time. The exercise should not cause pain to the baby!;
Same situation. The baby's legs are bent at the knees and pulled toward the chest, first one at a time, then simultaneously. The baby's back is slightly rounded;
The same position “on your back”. The legs are pulled to the chest without bending the knees: first together, then one at a time;
Alternate and simultaneous rotation of the child’s legs, bent at the knee and hip joints, inward and outward. Movements should be smooth, without jerking;
Exercise "bicycle". It is necessary to make movements with the child’s legs that imitate riding a bicycle;
Position "on your back". “Drawing” numbers in the air with straight legs, rotating in different directions, “scissors” exercise;
Exercise "palms" with the feet.

This is a basic, but not exhaustive, list of active exercises that have been proven effective in combating hip dysplasia in children. Between the exercises, you can lightly shake the child’s legs and stroke them a little, relieving tension.

The passive list of exercises includes massaging the joint and feet of the child, which help enhance the effect of therapeutic exercises. Active and passive exercises should be alternated.

Congenital dislocation of the hip joint (grade 3 dysplasia)

In this condition, the entire head of the femur is located outside the acetabulum. The dislocation occurred due to the fact that a contracture formed in the adductor muscle of the thigh. Those. the muscle cannot stretch even one millimeter. She pulled the femur out of its socket. The head of the femur is displaced upward and laterally by the force of the adductor muscles of the thigh.

The acetabulum is filled with fatty tissue. The lip of the acetabulum flattens and blocks the reduction of the head. The round ligament of the femur lengthens, the muscles of the hip joint shorten, contract and block the reduction of the head.

In the absence of appropriate treatment, late symptoms of dysplasia appear after a year. These include:

Late onset of child walking independently (after 2 years).
Incorrect (like a duck) gait.

Trendelenburg's sign.

Recommendations for performing gymnastics

The number of repetitions should be gradually increased. This is important, because at first the baby will be new to such movements and may not like it right away. You need to get used to them by gradually increasing the load and adding a variety of exercises.

During the session with the child, be sure to talk gently and calmly, sing songs or recite poems and jokes in order to relieve the child’s stress and turn therapeutic exercises into an exciting game. When the child is healthy, it is better not to take breaks in classes.

The main success of exercise therapy is its regularity. Exceptions include fever, illness, heart and nervous system problems. Before performing gymnastics, you should consult with specialists.

You need to monitor the baby's condition. If he is nervous and crying, then you can stop the gymnastics. Perhaps he was tired and the proposed load was too much for him. There is only one piece of advice: give the child a rest and continue classes another time.

Exercise therapy is part of the entire treatment. It is recommended to add massage performed by a specialist and physiotherapeutic procedures to the course.

With a serious degree of dysplasia, when the child is given a special splint or is prescribed wide swaddling, some types of exercises may not be possible to perform. You should not perform them if the splint or bandage becomes dislodged during their execution.

Efficacy and contraindications for massage

Massage for dysplasia is prescribed only by an orthopedic doctor and is part of a comprehensive treatment of pathology. As a result of the massage course:

the condition of the hip joints is stabilized;
the process of joint reduction improves;
the condition of muscle tissue improves;
motor function is normalized, incl. the number of movements increases;
muscle tone improves;
the movement of biological fluids improves;
child development improves.

Contraindications for the procedures are:

epilepsy;
exacerbation of hepatitis or diathesis;
hernia;
inflamed lymph nodes;
light weight;
violation of the integrity of the skin;
presence of congenital heart disease;
diseases of the nervous system;
diseases of the kidneys, liver, blood;
inflammation of muscle and bone tissue.

Checking the results

The effectiveness of exercise therapy should be assessed after each course of gymnastics (after 10-15 sessions). The assessment is carried out by an orthopedic surgeon during a standard examination. For a detailed analysis, an X-ray of the hip joints is taken. Based on it, the doctor can adjust the course of treatment by adding new treatment methods or removing unnecessary ones.

Hip dysplasia is very common: approximately every seventh baby. If left untreated, it will lead to joint loosening and instability. This is a direct path to disability.

Gymnastics gives noticeable results, especially when used early in the first months of a child’s life.

Modern treatment methods help you forget about the diagnosis forever, but it’s better not to go into professional sports. By the way, gymnastics is an excellent preparation for the first steps. Thanks to strong ligaments and muscles, the baby begins to walk faster.

Causes and mechanisms of development of hip dysplasia

A developmental defect of the hip joint is formed during the period of intrauterine development of the fetus as a result of the influence of a number of internal and external factors:

burdened heredity;
elderly parents;
endocrinopathies in the mother;
infectious diseases;
vitamin deficiency;
pathologies of the prenatal period - threatened miscarriage, toxicosis of pregnancy, pathological childbirth, increased radioactive background.

With hip dysplasia, the articular capsule is stretched, resulting in displacement of the femoral head, underdevelopment of the ligaments, and flattening of the acetabulum, which has an elliptical shape with a geometrically correct spherical femoral head.

The discrepancy between the congruence of the articulating surfaces of the hip joint becomes fixed during the development of the child. It leads to the fact that during walking the ability of the hip joint to perform the function of support is impaired. The joint experiences greater load per unit area of both articulating surfaces than a normal joint. This circumstance causes the development of degenerative changes in cartilage in a defective joint - secondary dysplastic coxarthrosis.

Symptoms

First of all, pay attention to the symmetry of the skin folds of the thigh, bearing in mind that with bilateral pathology this sign may not be visible. Asymmetry of skin folds is more informative in children older than 2-3 months of age. Skin folds in congenital hip dislocation are located at different levels and differ in depth and shape. The gluteal, popliteal and inguinal folds are of diagnostic importance. On the subluxated or dislocated side they are deeper and there are more of them. This symptom is observed in half of sick children and in itself has no diagnostic value. Adults should pay attention to such problems as: the manifestation of sharp pain in the hip area when walking or at rest, the inability to constantly move the limbs, pronounced shortening of the limb, lameness when moving. Often, adult patients may not realize that they have hip dysplasia. Only in a situation where joint dysfunction reaches a critical point does a person begin to suspect the presence of a problem. High elasticity of the ligaments and hypermobility of the joints in most cases helps in sports and does not cause discomfort, so the disease can be recognized only after an ultrasound or x-ray examination. If a congenital dislocation is not corrected in time, it can lead to the formation of a defective joint, shortening of the limb and impaired muscle function.

Treatment using the Nikonov method on muscles

Doctor Nikonov

Quote : My method of restoring mobility of the hip joint is based on restoring muscle mobility to its physiological norm. Using the Nikonov method on muscles with fixation of the problem muscle, I restore normal muscle stretching. With this effect, the hyaline layer completely covers the head of the femur at the hip joint. My method of treating dysplasia is the only effective one, since I know the real reason for the development of the disease.