The pathological tension of the muscles often hinders the use of the effective mobilization and manipulation methods of manual therapy for vertebral and vertebrogenal disorders. The elimination or overcoming of this kind of muscular tension requires an appreciable expenditure of the doctor’s strength and time. This is especially noticeable when there is an influx of patients, and that is why a search for reliable and easy methods, including apparatus, for relieving tension of muscles of the back and small of the back is justified. Accordingly our purpose was to study physiological effects of the stretching of the spine using the ‘Gravitrin’ autogravitational training device. (Figure 1).

  Object of the research. The ‘Gravitrin’ (certificate of conformity NROSS RU. IM 10.VOO285) is intended for the prevention and correction of functional disorders caused by degenerative-dystrophic diseases of the spinal column. The ‘Gravitrin’s’ influence on the organism is based on an individually measured axial stretching of a patient lying on the supportive surface of the device. This surface consists of transverse ribs placed elastically on longitudinally stretched ribbons. The ribs arranged above the lumbar region are inclined towards the head of the recumbent patient and those arranged below it are inclined towards the patient’s legs. Under the person’s weight the supportive surface of the ribs conforms to the adjacent part of the patient’s body, decreasing to the maximum extent the pressure on the soft tissues.This paves the way for the relaxation of the muscles of the back and the small of the back. Additionally, the supportive surfaces of every rib shift away from the lumbar region (Figure 2), creating a certain pulling effect which is transmitted via skin and soft tissues to the spinal column.
 

 
  

The efforts of each individual rib are relatively small, but collectively they create the stretching that is spread over the entire surface of the body. Evenly distributed stretching does not cause reflex muscle tension as can happen when the effort is concentrated in one place – for example, stretching with the help of weight. In this way the ‘Gravitrin’ can provide stretching of the spine effectively. Because the magnitude of the effort depends on the weight and form of the patient’s body the stretching force doses are measured automatically for each individual (average 8-12% of the body weight), eliminating complications. Method of working. Researches were conducted with the participation of 33 volunteers showing moderate clinical signs of spinal degenerative-dystrophic diseases. Before the start of treatment it was necessary to regulate the ‘Gravitrin’ apparatus, taking into account each patient’s anthropometrical characteristics, according to the instruction [3]. The positioning of the patient on the apparatus and the duration of the procedure (30 minutes) were in conformity with the method [3]. During the research it was necessary to: 1) question the participants in the test, 2) complete a questionnaire according to the SAN method (subjective evaluation of the condition [4], 3) measure the height of the participants in a sitting position, using a standard device for measuring height, 4) measure the length of the spine from seventh cervical vertebra to third lumbar vertebra with the help of the KU-A curvimeter, 5) measure the muscle tension of some participants (18 tests on 14 persons), using a myotonometer. Changing the height in the sitting position after treatment reflects the change in the length of the spinal column (because the intervertebral discs become higher) and also the change of curvature (lordosis and kyphosis) as a result of the changed tonus of the bending muscles. It also characterizes primarily the absolute length of the spinal column. The tension of the long back muscles and paravertebral musculature was gauged by their hardness. Muscle hardness was measured with a muscle tensometer, registering by the stock of the instrument the effort needed to create a depression of the given depth in the muscle mass in the region under examination [2]. The direction of the compressing of soft tissues with the stock was perpendicular to the surface of the skin. Efforts corresponding to a 6mm depression of the soft tissues (mostly of the muscles) were registered. Muscle tension was studied at middle chest level (5 th chest vertebra), lower chest level (12 th chest vertebra) and lumbar level (3 rd lumbar vertebra) of the spinal regions. The measurements were taken right and left at a distance of 3-4cm from the axis of the spinal column before and after treatment. The measuring was done with the patient lying on his stomach. Because the hardness of the muscles varies widely between patients the relative changing of the index (C) under the influence of the stretching on the ‘Gravitrin’ was in accordance with formula C= [(F1-F)/F] 100%. In the formula F1 is the effort with the stock to create the given depression after the procedure, F- the effort before the procedure. Additionally there was an examination of the coefficient of the asymmetry of the muscular tension (KAs), characterizing the asymmetry of musculature tonus right and left: KAs= [(Fd-Fs)/Fs] 100%, whereas Fd is the effort with the stock registered at the creation of the depression of the muscles on the right, Fs is the same effort measured on the left. The coefficients of the asymmetry before and after the procedure were compared. In our opinion the reduction of this index shows the decrease of the pathological asymmetry of the muscles tonus caused as a reflex at the level of the affliction by the pathological process of the spinal-motor segments. The results we received were worked out statistically, using a personal computer and the Microsoft Excel-98 programmed package.

Results of the research

. All the patients who took part in this experiment spoke of the comfort of lying on the ‘Gravitrin’. The pain and discomfort syndrome noticeably lessened already during stretching on the autogravitational apparatus ‘Gravitrin’. All patients spoke of ‘total relaxing’, ‘muscle lightness’, ‘freedom of movements’. In general they felt better, according to the SAN method, on average by 0.47 of a point (from 4.82 to 5.25 points). The changes are statistically reliable – p<0.01 according to the Wilcoxon twin T-criteria. The correcting procedure with the help of ‘Gravitrin’ autogravitational training apparatus led to a genuine increase averaging 0.73cm in the height of the sitting patients. The size of the increase varied from patient to patient. In 90.9% of patients there was an increase, and only for 9.1% of them was there no change. There was an increase of 0.5cm in 39.3% of cases, of 1.0cm in 48.5% and of 1.5cm in 3.3%. Because the change of height in the sitting position happens as a consequence of the lengthening of the spinal column and a reduction of its curvature following ‘Gravitrin’ treatment it is important to compare the received results with genuine lengthening of the spine. In a majority of cases (54.6% of all those observed) there was no genuine lengthening of the spine; in 30.3% of cases the lengthening registered was 0.5cm and in 15.1% of cases it was 1cm. The lengthening of the spine was registered in all cases where the increase of height in a sitting position was not less than 1cm. Remaining observations of increased height in a sitting position were connected with the diminishing of spinal curvature, as a rule in the case of chest kyphosis. This supposition is supported also by the fact that it is precisely in the region of the middle chest part of the spine (as will be shown) that the biggest reduction of muscle tonus has been registered. We have checked the quantity evaluation of the degree of tension in the muscles of back and lumbar regions. Muscle tension decreased on average in the middle chest region by 19.8% (p<0.01 according to z – criteria), in the lower chest region by 10.2% (p<0.01 according to z – criteria), and in the lumbar region by 19.2% (p<0.01 according to z – criteria). Of special importance is the discovery during the research of a clear tendency to eliminate the muscle asymmetry. It averaged 24.7% in the middle chest region (p<0.01 according to z – criteria), 13.1% in the lower chest region (p<0.01 according to z – criteria), and 28.1% in the lumbar region (p<0.05 according to z – criteria). Thus ‘Gravitrin’ promotes normalization of the functional condition of the muscle system connected with the system ‘spine’.

Discussing the results.

Received data provides direct and indirect evidence of the positive influence on the tonus of the muscles of the back and small of the back of stretching with the help of ‘Gravitrin’ autogravitational training device. First of all there are the results of the direct measuring of the hardness of the muscles. Under the influence of the treatment the hardness of the muscles definitely decreased in the majority of the people examined (65.7% of all those examined) including at the middle chest level 72.2% of all trials, at low chest level 55.6%, at lumbar level 69.4%. These differences are not reliable (p>0.05 according to the t – criteria Student), so it is better to base oneself on average figures. At the same time in the case of some individuals muscles tonus did not change and in some cases even increased a little: at middle chest level, 16.7% were unchanged and 11.1% increased. At lower chest level 27.8% were unchanged and 16.7% increased. At lumbar level the figures were 2.6% and 25% respectively. However, this last is not to be seen as a simple negative variant of the body’s reaction to the procedure. In a number of instances the increased muscle tonus on one side of the body (right or left of the spine) was justified and directed to reducing the muscles’ disequilibrium at the same anatomical level. In our opinion this is proved by the positive dynamic of the coefficient of the asymmetry. In 68.5% of all cases observed the muscle asymmetry decreased and only in 14.8% of cases did it increase a little. This increase was not considerable according to the relative value (not more than 25.7% relative to initial level), and according to absolute value about 20%. Decrease of muscle asymmetry during our research is not to be interpreted as a violation of the sanogenetic local miofixation (V. P. Veselovski [1]). Miotonometry reflected the condition of the undifferentiated muscle mass, first of all the long muscles of the back and small of the back, but not the short, deep, paravertebral muscles providing local miofixation. Because for technical reasons it is not always possible to carry out direct miotonometry we mostly judged the condition of the muscular tension from indirect indications. As an informative indirect indication we used the dynamics of height in a sitting position. The increase in height testifies to the reduction of the curvature of the chest kyphosis and lumbar lordosis that is possible with a reduction of the heightened muscle tonus. We registered the dynamics of height under the stretching influence of ‘Gravitrin’ and came to the conclusion that the leading contribution to the changed curvature of the spinal column bears witness to the fact that in most cases the change in height is not accompanied by a genuine lengthening of the spine or that this lengthening is less than the increase in height. Thus single stretching with the ‘Gravitrin’ autogravitational training device leads to a genuine reduction of the pathological tension of the muscles of the back and small of the back which can make noticeably easier the treatment with manual therapy of patients with vertebrogenic pathology. Because the ‘Gravitrin’ is absolutely safe and does not require the permanent presence of medical personnel during treatment, the employment of this apparatus can be exceptionally useful when there is a flood of patients.

Conclusions

1. The ‘Gravitrin’ is an effective method for reducing pathological tension of the muscles of the back and small of the back, as is proved by the results of direct measuring and indirect indications.
2. Under the influence of a single half-hour stretching on the ‘Gravitrin’ the following effects testify to a reduction of muscle tonus: 1. A reduction of hardness of back and lumbar muscles of 10.2 – 19.8% and the asymmetry of the muscle tonus of 13.1 – 28.1%; 2. An increase in the height of the patient in the sitting position averaging 0.75cm, which testifies to a reduction of the curvature of the spinal column because of relaxation of the muscles; 3. The ‘Gravitrin’ can usefully be employed at the preparatory stage for conducting manual therapy for patients with vertebrogenic disorders.

    

Literature

1. V. P. Veselovski ‘Practical Vertebroneurology and Manual Therapy’ – Riga, 1991, 344 p.
2. G. A. Ivanichev ‘Manual Therapy’. Guidance, atlas. - Kazan, 1997, 448 p.
3. Complex Methodic of the Diagnostic and Physiotherapeutic Correction of the Functional Condition of the Human Spine: Methodical Recommendations. Moscow, 2002, 32 p.
4. S. A. Litaev, Y. N. Shanin, S. B. Shevchenko ‘The Adaptive Mechanisms of the System of Movement’ – St Petersburg: ELBI - SPb, 2001, 270 p.

 

’The Manual Therapy’, scientific-practical magazine 2004, ISSN 1684 – 6753