Травмы, стереотипные, избыточные или неправильно распределенные нагрузки на позвоночник постепенно приводят к дегенеративным изменениям в межпозвонковых дисках, а затем и к грыже. Этот процесс зачастую сопровождается болями в спине, выраженным дискомфортом в различных отделах позвоночника, но может проходить и бессимптомно. Грыжей межпозвонковых дисков страдает 12–35% людей в разных странах.
Хорошая новость состоит в том, что хроническая форма грыжи межпозвоночных дисков наблюдается только в 10% случаев. Однако облегчить состояние больного порой бывает непросто.
Грыжа позвоночника: что это?
Межпозвонковый диск — это амортизатор и фиксатор позвонка, который в норме у взрослого человека имеет диаметр около 4 см и толщину около 1 см. Благодаря межпозвонковым дискам возможны нормальная подвижность позвоночника и правильное распределение нагрузки на позвоночный столб.
Основными элементами межпозвонковых дисков являются:
- Пульпозное ядро, состоящее из хаотично расположенных коллагеновых волокон и радиально расположенных эластичных. Ядро насыщено водой, которая обеспечивает сопротивление компрессии, и на обывательском уровне сравнимо с плотным желе. С возрастом содержание воды в ядре снижается: если у младенцев оно составляет 90%, то у людей старше 70 лет — уже 60%.
- Фиброзное кольцо — слоистая структура из 25 эластичных пластин, между которыми находятся слои коллагена.
- Хрящевые замыкательные пластинки — защита диска от позвонков сверху и снизу толщиной около 1 мм.
Если после травмы, а также в результате запущенного остеохондроза, в силу возраста или неправильных нагрузок пульпозное ядро начинает приобретать фиброзированную (измененную) структуру, то межпозвонковый диск перестает нормально функционировать. В результате позвоночник деформируется, давление позвонков на диски неверно перераспределяется, и пульпозное ядро одного из дисков может сместиться с разрывом окружающего его фиброзного кольца. Такое смещение и называется межпозвоночной грыжей. Локализация грыжи наиболее распространена в пояснично-крестцовом отделе позвоночника, хотя иногда она может появиться и в шейном отделе. Крайне редки случаи грыжи в грудном отделе.
Симптомы грыжи позвоночника
Признаки патологии различаются в зависимости от локализации грыжи. Если пострадал пояснично-крестцовый отдел, больной ощущает боль в области поражения диска, усиливающуюся при нагрузке. Также возможны:
- боль с отдачей в ягодицу со стороны повреждения диска;
- покалывающие ощущения в районе поврежденного диска;
- онемение ноги на стороне поражения диска;
- периодическая слабость и потеря чувствительности в обеих ногах;
- дисфункция выводящей и половой систем.
Для грыжи в шейном отделе характерны:
- «прострелы» в плечо или руку;
- головокружения и/или головные боли;
- скачи артериального давления;
- утрата чувствительности в пальцах рук.
Если грыжа развилась в грудном отделе, больной испытывает боль, пытаясь занять типичное рабочее положение, кроме того, может возникнуть хроническая боль в груди с дальнейшим развитием кифосколиоза или сколиоза.
Для уточнения диагноза всегда делается МРТ (магнитно-резонансная томография) или КТ (компьютерная (рентгенологическая) томография). Если межпозвоночный диск выпячен на 25–50% своего диаметра — это грыжа. Если больше, то речь идет уже о выбухании (протрузии) диска.
УВТ при грыже позвоночника
Ударно-волновая терапия получила известность в 1990-х годах как одно из средств ортопедии, травматологии, косметической и спортивной медицины. В России первые аппараты УВТ появились в 1997 году.
Сегодня УВТ применяется как элемент комплексной терапии целлюлита (подкожной липодистрофии), «пяточных шпор» (плантарного фасциита), «теннисного локтя» (эпикондилита), плохо сросшихся переломов различных костей, артрозов, остеохондроза позвоночника и его осложнений.
В основе терапии лежат свойства ударных акустических волн частотой до 16 Гц (порог, начиная с которого звуки воспринимаются человеческим ухом). Инфразвуковые колебания модулируются с тем, чтобы при небольшой длительности получить высокую энергию импульса. Эффект похож на точечные поколачивания при массаже, только с большей частотой.
Принцип действия ударных волн
Проникая в организм, инфразвуковая ударная волна без задержки проходит сквозь жидкости, мягкие ткани и мышцы. В костной и хрящевой тканях она тормозится, вследствие чего высвобождается энергия, способная разрушить патологические структуры, например остеофиты в позвоночнике. Напряженные мышцы, имеющие высокую плотность, под действием ударной волны расслабляются, снимается мышечная боль.
Противопоказания
В отношении УВТ действуют общие противопоказания к физиотерапии. Это острые инфекции, нарушения свертываемости крови, онкология, эпилепсия, психические заболевания, наличие кардиостимулятора. Кроме того, нельзя подвергать воздействию ударной волны череп и зоны крупных (магистральных) сосудов.
Как проводится лечение позвоночника методом ударно-волновой терапии
УВТ похожа на аппаратный массаж: по телу пациента водят излучателем в течение примерно получаса. Излучатели бывают с фокусирующей и рассеивающей головкой. Рассеивающую головку применяют для лечения целлюлита, фокусирующую — для сильного направленного воздействия на проблемные зоны в случае патологий опорно-двигательного аппарата, для воздействия на болевые (триггерные) точки, в специфических случаях — для лечения некоторых урологических заболеваний у мужчин. При грыже межпозвонковых дисков обычно требуется курс из 15–20 процедур с периодичностью 1–2 раза в неделю, но все зависит от индивидуальной клинической картины.
Использование излучателя с фокусирующей головкой позволяет волне проникнуть на глубину до 4 см. Обычно этого достаточно для воздействия на позвоночник. Однако, если пациент имеет лишний вес и слой подкожного жира у него толстый, эффективность терапии снижается, так как сквозь плотные жировые ткани волне сложнее пробиться.
Результаты применения УВТ в лечении грыжи позвоночника
При мышечной боли ударные импульсы действуют аналогично массажу. За счет этого мышечный тонус нормализуется, что положительно сказывается на положении позвонков и межпозвоночных дисков. Улучшается кровообращение и отток лимфы, пациент чувствует облегчение своего состояния. Иногда пациенты считают, что именно курс УВТ ставит межпозвоночный диск на место. Но это неверно. Ударно-волновая терапия при грыже позвоночника может быть только вспомогательным методом лечения, повышающим эффективность лечения в целом.
Комплекс консервативных лечебных мер, помимо УВТ, должен включать массаж (мануальную терапию), ЛФК, диетотерапию, коррекцию осанки и ежедневных бытовых нагрузок. Только в этом случае можно добиться длительного улучшения состояния пациента и восстановления позвоночника примерно на 80%. Следует учитывать, что межпозвонковая грыжа обычно является результатом запущенного остеохондроза, и восстановить позвоночник на 100% не удастся. Однако повторение курса УВТ один, иногда два, раза в год поможет поддерживать тонус мышц, вовремя разбивать нарастающие остеофиты, фиброзные образования, и снять неприятные ощущения в спине.
Консервативное лечение в тяжелых случаях (например, после травм позвоночника с множественными грыжами и защемлениями нервов) не может быть заменой операции. При подтвержденных показаниях к замене межпозвонковых дисков искусственными нельзя тянуть с хирургическим вмешательством. В этом случае весь комплекс консервативных терапевтических мер назначается уже после хирургической операции, в период реабилитации.
Важна квалификация врача-физиотерапевта, так как при неправильной работе с аппаратом и приложенных к проблемным зонам излишних усилиях пациент может испытывать боль. Иногда это является вариантом нормы, иногда — нет. Обычно современное оборудование УВТ оснащается «искусственным интеллектом» — компьютером со встроенными медицинскими протоколами проведения процедур, которые не допускают или, по крайней мере, снижают до минимума возможность человеческой ошибки. Более того, инновационные генераторы звуковой волны (расположенные в наконечниках) оснащены системой обратной связи, которая в режиме реального времени способна изменить интенсивность энергетического воздействия, чтобы не допустить повреждений ткани.
Отзывы пациентов с форума Medhouse.ru:
Людмила: «Во время процедуры было больно, но терпимо. В особенности больно было непосредственно вблизи крестца. И до сих пор болезненные ощущения там остались. Делала процедуру вчера утром».
Анастасия: «Не знаю, как у других, но я при проведении процедур не испытывала никакой боли. Возможно — легкий дискомфорт, но не более того. У зубного врача или гинеколога — значительно неприятнее! 2–4 сеанса — не знаю, возможно, этого достаточно при определенных заболеваниях, но я почувствовала облегчение только после седьмой или восьмой процедуры. Зато потом с каждым сеансом боли становились все меньше и меньше и к двадцатому сеансу (через три недели после начала лечения) исчезли полностью».
Мария: «После окончания первого курса грыжи уменьшились — одна на 94%, вторая на 68%. Сейчас уже несколько месяцев забыла о болях в спине, изредка прихватывает левую ногу, в основном когда мою пол или работаю, согнувшись в пояснице, но это совершенно несопоставимо с тем, что было раньше».
АФРивер: «…Его [прим. редакции — УВТ] применение в комплексном лечении, как определенная составляющая — очень даже эффективно. Но это всего лишь инструмент для достижения определенных целей в работе над больным местом (убирали остеофиты, фрагментации. больше не могу воспроизвести, я не врач)».
Стоимость терапии
Еще несколько лет назад аппараты УВТ можно было найти в Москве всего в нескольких ведомственных клиниках, куда сложно было попасть. Сомневаясь в отечественной медицине, многие пациенты отправлялись в Израиль или Германию. Конечно, это было крайне дорогое лечение. Однако в настоящее время для лечения боли в позвоночнике и суставов методом ударно-волновой терапии не требуется десятков тысяч долларов, как раньше.
Одна процедура УВТ в Москве в среднем стоит всего 1200–1500 рублей, что при частоте процедур 1–2 раза в неделю является вполне доступной суммой.
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Пяточная шпора (фасциит) доставляет много проблем своему владельцу. Человек испытывает постоянную боль, не может полноценно передвигаться и жить полноценной жизнью.
Современная медицина подходит к лечению фасциита комплексно, сочетая медикаментозную терапию с физиопроцедурами и разгрузкой пятки при помощи стелек и подпяточников.
Отличные результаты дают физиопроцедуры при пяточной шпоре, основанные на ударно-волновом воздействии (УВТ). Данную методику используют на любых стадиях болезни, помогая пациенту быстро избавиться от боли и уменьшить костно-солевой нарост.
Как работает ударно-волновой метод лечения пяточной шпоры?
Впервые УВТ была применена в 90-х годах в немецких клиниках для лечения патологий суставов. Сейчас УВТ-аппаратами оснащены практически все государственные поликлиники и частные медцентры.
Врачи рассматривают лечение пяточных шпор ударно-волновой терапией как альтернативу операции по удалению шпоры. Оказываемое прибором воздействие позволяет устранить шип, не повреждая здоровые ткани пяточной фасции.
Во время процедуры УЗ-волны точечно воздействуют на пораженную зону определенной частоты только на костно-солевые клетки, образующие шпору. Здоровые клетки соединительной ткани не подвергаются воздействию ударных волн, т.к. надежно защищены клеточной мембраной.
Процедура эффективно на любой стадии: когда симптомы пяточной шпоры только появились и когда шип имеет уже внушительные размеры.
УВ-терапия обладает следующими эффектами:
- снижает интенсивность болевых ощущений;
- разбивает солевые отложения образующие шип;
- активизирует метаболизм и кровообращение фасции;
- уменьшает отеки, выводит токсины;
- устраняет спазмы.
Как проходит процедура УВТ при пяточной шпоре?
Перед тем, как прописать курс УВТ врач-ортопед назначает анализы крови (общий и на коагуляцию), а также отправляет пациента на рентгенографию для уточнения места локализации костной шпоры. Если рентген окажется недостаточно информативным врач рекомендует пройти МРТ.
УВТ проводится в специализированном физиотерапевтическом кабинете при помощи аппарата, испускающего УЗ-волны. Пациент ложится на кушетку или усаживается в кресло и кладет стопы на специальную подставку. Физиотерапевт наносит на пятки гель-смазку и устанавливает датчик аппарата таким образом, чтобы испускаемые ударные волны воздействовали точно на шпору.
После включения аппарат испускает импульсы, которые проникают на 4-5 см в ткани стопы. В отличие от лечения пяточной шпоры рентгенотерапией, УВТ не затрагивает кости — волны беспрепятственно проходят только через мягкие ткани и отражаются от костных.
Длительность процедуры устанавливается индивидуально и составляет от 10 минут до получаса.
Дробление пяточной шпоры ударно-волновой терапией не доставляет боли, но во время сеанса пациент может испытывать легкий дискомфорт. Если болевые ощущения значительные, то воздействие УВТ-аппарата прекращают до выяснения причин и устранения болей.
Эффект от физиопроцедур во многом зависит от того, как лечат пяточную шпору врачи. Если пациент одновременно с УВТ принимает назначенные медикаменты и использует специальные разгружающие качественные подпяточники при шпорах, то эффект можно увидеть и ощутить уже после 2-3 процедур.
Всего для избавления от шпоры, как правило, необходимо до 8 сеансов с интервалом 2-5 дней. После окончания процедуры костный шип продолжает некоторое время разрушаться.
Поэтому в период между сеансами необходимо использовать мази Пяткашпор на основе желчи, которые также способствуют устранению нароста, повышая эффективность физиотерапии.
Сколько стоит ударно волновая терапия пяточной шпоры?
Курс УВТ при пяточной шпоре, цены на процедуру достаточно высокие, проводится амбулаторно без помещения в стационар. Стоимость 1 сеанса составляет от 600 до 1300 рублей в зависимости от региона, уровня лечебного учреждения, применяемого оборудования, а также длительности процедуры.
В большинстве случаев клиники делают приличные скидки для пациентов, которые хотят пройти полный курс физиопроцедур и чередуют УВТ и, например, лазерную терапию при пяточной шпоре.
Во время лечения необходимо обеспечить разгрузку стопы в области пятки, иначе результативность терапии значительно снизится. Для этого в течении дня необходимо носить разгружающие амортизирующие подпяточники.
Учитывая достаточно высокую стоимость УВТ-терапии, больному необходимо объективно оценить все ее достоинства и недостатки:
Достоинства:
- отсутствие побочных эффектов;
- реальный шанс избежать операции по удалению шпоры;
- простота проведения процедуры;
- минимальные затраты времени (не более получаса).
Недостатки:
- наличие противопоказаний;
- возможность повторного появления шипа, если не устранить причину его появления;
- высокая стоимость.
Ударно-волновая терапия пяточной шпоры: противопоказания
Внимание! При наличии металлических пластин и штифтов можно беспрепятственно проводить лечение УВТ.
Насколько эффективно лечение пяточной шпоры УВТ?
Специалисты в сфере физиотерапии и ортопедии сходятся во мнении, что ударно-волновая терапия пяточной шпоры хоть и эффективна, но не дает гарантий полного избавления от фасциита.
Главная причина низкой эффективности — УВТ не может устранить причины появления шпорного нароста. Для этого пациент должен пройти комплексное лечение и устранить провоцирующие факторы, влияющие на появление шпоры.
Подробнее о том, как вылечить пяточную шпору и не допустить рецидива, вам расскажет лечащий врач.
Комплексное лечение включает в себя:
- прием противовоспалительных препаратов;
- использование местных нестероидных средств;
- физиопроцедуры и ЛФК;
- снижение нагрузки на стопы.
Для уменьшения статической нагрузки рекомендуется применять страсбургский носок на ночь, который фиксирует ноги таким образом, что фасции пятки оказываются в анатомически растянутом положении, способствующем их быстрому восстановлению.
В дневное время во время ходьбы необходимо приобрести силиконовые стельки для ношения при шпорах, снижающие нагрузки на пятку и всю стопу. Без этих ортопедических приспособлений лечение будет малоэффиктивным, т.к. фасции будут постоянно подвергаться травмированию.
УВТ при пяточной шпоре: отзывы о процедуре
Безболезненность, эффективность и возможность избежать операции — вот о каких преимуществах говорят пациенты, использовавшие этот метод. Врачи также считают, что лечение пяточной шпоры ударно-волновой терапией, отзывы о котором в основном положительные, является одним из самых безопасных и результативных консервативных методов лечения.
95% людей с пяточной шпорой отмечают выраженную положительную динамику при УВТ-лечении, а 30% говорят об уменьшении боли уже после первой процедура.
Мнение врача-ортопеда: "На сегодняшний день УВТ — эффективное средство безоперабельного удаления шпор. Если в поликлинике имеется такое оборудование, то пациенту рекомендуется пройти лечебный курс в дополнении к традиционному лечению медикаментами. При этом важно соблюдать охранительный режим — не допускать воздействия нагрузки на пятку в период лечения, а также после него в целях избежание ее повторного появления".
Во время лечения не забывайте о разгрузке пятки во время ходьбы. Для этого отлично подойдут качественные ортопедические стельки с пяточным амортизатором.
1. Почему отзывы недостоверны
Как понять, ударно-волновая терапия это панацея или развод на деньги? Для начала хочется сказать что: при выборе того или иного способа лечения отзывы людей в интернете не лучший советник. Читатель может не согласиться с нами, но это действительно так, по ряду причин:
- во-первых, компании заказывают или печатают сами в интернете положительные отзывы, тем самым вводя в заблуждение клиентов — для получения лояльности клиентов и увеличения количества продаж (услуги или лекарства);
- во-вторых, всегда существуют конкуренты, которые могут написать на своего оппонента "отрицательные, черные" отзывы.
- в-третьих, чтобы получить, более или менее приближенное к правде представление о предмете отзыва, необходимо перечитать большую массу сообщений-отзывов;
- в-четвертых, внушаемому человеку — может помочь даже датчик УЗИ, если перед этим рассказать о чудо-эффекте ультразвукового воздействия;
- в-пятых, в-всегда найдутся недовольные, ворчливые пациенты, которые ходят по больницам, и подсознательно сопротивляются лечению, только для того чтобы потом жаловаться (находя в этом скрытое удовольствие): "какие тупые и безрукие врачи не могут меня вылечить".
- и наконец, УВТ терапия помогает не всем пациентам, как и многие другие современные методы лечения.
2. Исследования ученых — как альтернатива отзывам
Что же может быть опорой в принятии решения при выборе ударно-волновой терапии для лечения Вашего заболевания, если отзывы пациентов — недостоверный источник? Наш ответ — четко спланированные врачами эксперименты — вот основа для принятия правильного решения. Если Вы расскажите врачу о чудо-методе, с помощью которого исцеляются много людей, то первое о чем он спросит: а исследования, и непременно "слепые" проводились? Ведь люди существа внушаемые, поэтому даже стаканом простой воды врач может вылечить до 10 % тяжело больных (и при этом внушаемых пациентов), просто сказав перед лечением, что это "активированная вода с помощью синхрофазатрона, и насыщенная ионами яда змеи, — излечиваются даже неизлечимые". Шутки-шутками — но внушаемость присутствует всегда, при лечении любым препаратом. Именно для этого и существуют эксперименты, которые "очищают" от эффекта внушения и дают реальную картину эффективности лечения. Ученые дали названия данному способу — "слепое исследование". Слепое — потому, что половина участников эксперимента (имеющие определенные проблемы со здоровьем) получают проверяемое лечение, например УВТ, а вторая половина — не получают; и при этом сами участники не знают о том, в какой они группе. Это делается с целью исключения эффекта внушения (плацебо эффекта).
Плаце́бо (от лат. placebo, буквально — «буду угоден, понравлюсь») — вещество или метод лечения без явных лечебных свойств, используемые в качестве средства лечения болезни, лечебный эффект которого связан с верой самого пациента.
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