Pranayama: breathing techniques, full yogic breathing and rhythmic breathing. Massage of the muscles involved in the breathing process Massage of the muscles involved in the breathing process

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Manual massage of the muscles involved in the breathing process

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Full breath- This is natural breathing in a process in which the volume of the lungs is fully utilized. A person also learns to coordinate the work of the muscles involved in the breathing process (diaphragm, muscles of the back, abdomen and chest). When performing the technique, it is necessary to achieve naturalness, evenness, and smoothness of inhalation and exhalation.

Mastering technology.
In order to master full breathing you need time and regular practice. Conventionally, we can say that the technique of full breathing is mastered if a person is able to breathe at a frequency of one respiratory cycle per minute for at least 10 minutes.

For the first three to four months, you should practice every day (preferably in the morning and evening), devoting 15-20 minutes to the lesson. For beginners, the most optimal position for practice is lying on your back, with your back completely pressed to the floor.

Execution technique.
We lie down calmly on a flat, horizontal surface. Gently roll out the spine on the mat.

We stretch from the sacrum to the back of the head - we stretch the spine “into a string”. We place our feet hip-width apart, with our heels under our knees. We place our hands along the body, palms down. We gently press our back into the floor.

With an inhalation, we raise and lower our straight arms behind the head, while evenly expanding the stomach forward and to the sides. Pause after inhalation for 4-6 seconds.

With an exhalation, we raise and lower our straight arms along the body, while we evenly draw in the stomach, and slightly turn the pelvis towards the head. Pause after exhalation for 4-6 seconds.

Observe the sensations of the body, completely relax the face.

We gradually lengthen the respiratory cycle in time (inhalation phase, delay after inhalation, exhalation phase, delay after exhalation). A breathing cycle of one minute is considered optimal.

We do 10-12 breathing cycles, gradually placing our hands on the body (one palm on the chest, the other on the stomach). With inhalation, we evenly fill the stomach, continuing to inhale, fill the chest. As you exhale, lower your chest and lower your stomach. We do another 10-12 breathing cycles.

Main effects of practice:
— reducing the load on the cardiovascular system;
- improvement of venous return;
- relieving excess tension from the back muscles;
— decompression effect on segments of the spinal column;
— correction of postural disorders;
— training of the external respiration apparatus;
- restoring the balance of the nervous system;
— reduction of mental stress and chronic fatigue syndrome;
- restoration of vitality;
— formation of an even emotional background.

Contraindications:
- exacerbation of inflammatory processes,
- bleeding.

PRIVATE METHODS

CLASSICAL THERAPEUTIC MASSAGE

FOR VARIOUS DISEASES

Massage for respiratory diseases

The effect of massage on the respiratory system.

Various types of chest massage improve respiratory function and relieve fatigue of the respiratory muscles.

Massage improves the function of external respiration, increases the saturation of arterial blood with oxygen, normalizes cortico-visceral relationships, musculocutaneous and neurovascular reactions.

In the pulmonary system, it restores and improves peripheral and pulmonary circulation, shortens treatment time, stimulates the evacuation and drainage function in the bronchi, strengthens the respiratory muscles, improves chest mobility, promotes hardening and strengthening of the whole organism.

Under the influence of massage, gas exchange increases. The aftereffect of massage is manifested in the normalization of the acid-base state, in increasing the elasticity of the lung tissue, bronchial patency and respiratory reserves.

Vigorous, but not prolonged, massage of the chest using techniques such as effleurage, rubbing and chopping promotes a reflex deepening of breathing, an increase in the minute volume of breathing and better ventilation of the lungs.

It is rational to prescribe massage to patients with bronchopulmonary pathology in accordance with motor modes, since a massage procedure for a patient can be regarded as passive physical activity.

Massage and movement regimens for patients with respiratory diseases.

In a hospital setting, depending on the severity of the patient’s condition and treatment objectives, the attending physician recommends and prescribes one of the following motor modes:

I-A- strict bed,

I-B- lightweight bedding,

II- semi-bed or ward,

III-A- free or general transitional,

III-B– general mode.

The purpose of the motor regimen depends on the severity of the disease, its course and other factors.

As the patient's condition improves, the patient is consistently transferred to the next motor mode.

Strict bed rest (I-A). Corresponds to the acute period of the disease. The patient's general condition is serious. In the clinic: high temperature, sharply increased ESR and high leukocytosis.

The patient is prohibited from independent movements, including changing position, in order to create the greatest peace.

In this motor mode, massage and therapeutic exercises are contraindicated.

Light bed rest (I-B) It is prescribed when the patient’s general condition improves, the temperature decreases, the ESR slows down and the blood tests and other laboratory parameters tend to normalize. The patient is allowed, independently or with the help of medical personnel, to perform a number of active movements of the limbs, eat, turn over in bed, perform the toilet, and move to a sitting position.

During this period, against the background of ongoing drug therapy, massage of the limbs and the anterolateral surface of the chest, and therapeutic exercises are prescribed.

Objectives of massage: increase the overall tone of the body, normalize the function of the respiratory organs and cardiovascular system, stimulate the processes of resorption of existing foci of inflammation.

To improve peripheral circulation and facilitate the work of the heart, as well as to stimulate pulmonary circulation, a massage of the extremities is prescribed. The extremities are massaged according to a general massage scheme using all appropriate techniques of medium intensity on these areas. Each limb takes from 5 to 7 minutes.

With further stabilization of the patient's general condition, the massage procedure includes massage of the anterolateral surface of the chest in the initial position of the patient lying on his back. Light and short stroking and rubbing are used, paying attention to massage of the sternum and parasternal area, since this reflexively dilates the bronchioles and intercostal space, respiratory function improves. The duration of the massage is 5-10 minutes.

Semi-bed or ward (II) mode(with satisfactory general condition of the patient, normal temperature and improvement in laboratory parameters). The patient is allowed to sit, stand up, and carefully walk within the ward to expand motor activity.

Z massage benefits and therapeutic exercises: further strengthening of the body, stimulation of the processes of resorption of foci of inflammation in the lung tissue, prevention of complications, activation of mechanisms of nonspecific reactions of adaptation of the body, promoting recovery and recovery.

The intensity and duration of the massage are gradually increased, and deeper techniques are added to the massage procedure. Massage the chest from all sides, including the shoulder girdle areas. The massage can be performed in the patient's original position (IP) - sitting.

Free or general transitional (III-A) mode. The patient's condition is satisfactory, moderate walking, climbing stairs, short walks, etc. are allowed.

Objectives of massage: further restoration of the functions of the cardiovascular and respiratory systems, adaptation of the body to physical activity.

Massage the chest on all sides. The massage is used at medium intensity, gradually increasing the strength and duration, using all the most effective and rational massage techniques. Particular attention is paid to the articulations of the ribs with the sternum and spine, and to the intercostal spaces.

Free (III-B) mode. Prescribed before discharge of patients from the hospital. The main tasks of this period: adaptation of the patient to everyday stress, elimination of reversible residual effects after an illness, further training of compensatory mechanisms.

A chest massage is used from all sides or a general massage with an emphasis on the chest. They use all massage techniques that are rational for the areas being massaged, taking into account the individual characteristics of each patient. The duration and intensity of the massage is increased gradually.

Contraindications to massage for respiratory diseases:

acute inflammation of the respiratory system and severe general condition of the patient, active pulmonary tuberculosis, malignant and benign tumors, hemoptysis.

1.2. Methodology classical massage for pneumonia.

Acute pneumonia is an inflammation of the lung tissue, predominantly of a bacterial nature. In some cases, the disease begins suddenly, against the background of complete health, with an increase in body temperature to 39-40°, chills, chest pain, cough, initially dry, then with sputum, sometimes with hemoptysis. This is lobar pneumonia.

Clinic of focal pneumonia: fever, chills, cough. But it does not begin as suddenly as lobar pneumonia. Usually, a few days before this, signs of acute respiratory viral infection or flu appear: runny nose, cough, malaise, aches throughout the body, slight fever. The second wave of the disease is characterized by increased temperature, increased cough, weakness, and sweating. In some cases, pneumonia is characterized by a somewhat blurred picture of the course of the disease. Pneumonia may be hiding under the mask of ARVI. Its signs: low temperature, weakness, malaise, moderate cough.

In all cases, you should consult a doctor, since only after listening to the patient, an X-ray examination and a blood test can you diagnose acute pneumonia and select a remedy for treatment.

For all types of acute pneumonia, it is necessary to use antibiotics, which are best administered by injection. In addition, expectorants, bronchodilators that promote mucus separation, and physiotherapeutic methods are used.

Massage begins after acute symptoms subside during the period of reverse development of the disease with satisfactory general condition and normal temperature. The presence of weakness and pain in the side are not contraindications to massage and therapeutic exercises.

At the stage of light bed rest The massage is performed in the IPP while lying down. The anterolateral surface of the chest and lower limbs are massaged for a reflex effect on peripheral circulation. Apply superficial plane stroking, alternating rubbing, deep plane stroking, sawing, grasping stroking in two rounds. The duration of the massage procedure is 5-10 minutes. When massaging the limbs, the techniques of grasping stroking and light or medium intensity rubbing are used.

When transitioning from bed rest to ward rest The massage begins from the back surface of the chest in the IPP lying or sitting:

2. Alternate rubbing of medium intensity.

3. Superficial planar spiral stroking.

4. Sawing.

5. Ironing (1 option).

6. Spiral rubbing with four fingers, grasping the shoulder girdle.

7. Embracing stroking in two rounds.

8. Light patting or tapping.

9. Superficial planar stroking.

Then massage the anterolateral surface of the chest:

1. Stroking in two rounds.

2. Alternate rubbing.

3. Ironing (2nd option).

4. Medium intensity sawing.

5. Separate-sequential stroking.

6. Spiral rubbing with four fingers parasternally and along the intercostal spaces.

7. Rake-like stroking along the intercostal spaces.

8. Linear rubbing along the intercostal spaces.

9. Lightly patting the entire anterolateral surface of the chest.

10. Superficial planar stroking or stroking in two rounds.

During the period of the ward regime massage the chest from all sides. When massaging the back, special attention is paid to rubbing the soft tissues near the spine, the interscapular area, the area of ​​the shoulder blades, the area under the lower angles of the shoulder blades and along their inner edge:

1. Superficial planar stroking.

2. Vigorous alternating rubbing with gripping the neck and shoulder girdle.

3. Embracing stroking in two rounds.

4. Vigorous sawing involving the neck and shoulder girdle.

5. Deep separate-sequential stroking.

6. Deep spiral rubbing, especially carefully along the spine.

7. Ironing (2 option).

8. Semicircular kneading.

9. Vigorous, but not frequent, patting.

10. Superficial planar stroking.

On the anterolateral surface of the chest the following is used:

1. Embracing stroking in two rounds.

2. Alternate rubbing.

3. Ironing (2nd option).

4. Separately - sequential stroking.

5. Spiral rubbing.

6. Vigorous rake-like rubbing of the intercostal muscles.

7. Rake-like stroking.

8. Vigorous, but not frequent, patting.

9. Embracing stroking in two rounds.

In free motor mode A general massage is indicated, but more often a chest massage is used from all sides. When massaging the back, the techniques of transverse continuous kneading, semicircular kneading, and rolling are added to the previous techniques. Focus on massaging the interscapular area, the area of ​​the shoulder blades, under the lower angles of the shoulder blades and along their inner edge.

On the anterolateral surface of the chest, the same techniques are used as in the previous mode, but with slightly greater force and intensity.

The duration of chest massage on all sides gradually increases to 15-20 minutes. Course of 12-15 procedures daily. After a month, it is advisable to conduct a second course of massage.

Massage for respiratory diseases

With inflammation of the bronchi (bronchitis), the leading syndrome becomes bronchial obstruction for the movement of air and secretions (sputum) due to a decrease in the lumen of the bronchi - obstruction (narrowing), transient (for example, with bronchial asthma) or constant and increasing in intensity (with chronic obstructive bronchitis)

An equally important ventilation disorder is restrictive syndrome. For example, with focal and lobar pneumonia there is a decrease in the respiratory surface of the lungs. A decrease in lung volumes in these diseases, especially with concomitant inflammation of the pleura, can be caused by a conscious limitation of chest excursion due to severe pain. In the chronic course of pneumonia, when there is a true decrease in lung tissue (its sclerosis), as well as when the mobility of the lung itself is limited due to the development of adhesions that prevent its expansion, restrictive ventilation disorders are also found.

In pathogenesis respiratory failure Discoordination in the work of various groups of respiratory muscles (for example, upper thoracic and lower thoracic) is of great importance. It is known that before and at the very beginning of muscular work, breathing intensifies according to the mechanism of a conditioned reflex. The inclusion in rehabilitation treatment of massage procedures and exercises associated with the movement of the upper and lower extremities and coinciding with the phases of breathing becomes a conditioned reflex stimulus for the activity of the respiratory apparatus and contributes to the formation of a conditioned proprioceptive respiratory reflex in patients. Ultimately, the use of the listed means of restorative treatment leads to a more coordinated operation of the costal-diaphragmatic breathing mechanism with a greater ventilation effect and less energy consumption for breathing.

An improvement in blood flow in working muscles during massage and physical exercise causes a decrease in resistance to blood flow in the periphery, which in turn facilitates the work of the left half of the heart. The latter is extremely important in patients of older age groups with concomitant lesions of the cardiovascular system (hypertension, myocardial dystrophy, etc.). At the same time, venous blood flow to the right working muscles is facilitated. In addition, the expansion of the peripheral vascular bed is accompanied by an increase in the surface of contact between blood and tissue cells, which, in combination with more uniform ventilation of the alveoli, leads to increased oxygen utilization.

Main goals: general improvement of the body, strengthening the respiratory muscles, increasing pulmonary ventilation and gas exchange, improving chest mobility.

Physical exercises and massage improve mucus production and form an optimal pattern of full breathing with an extended exhalation.

Massage plan: impact on the paravertebral and reflexogenic zones of the chest, indirect massage of the diaphragm, lungs and heart area, breathing exercises.

Patient position- sitting and lying down.

Massage is prescribed after acute symptoms have subsided during the period of reverse development of the disease with satisfactory general condition and normalization of temperature. The presence of weakness and pain in the side is not a contraindication to the use of massage.

Therapeutic massage technique

Massage of paravertebral zones L5-L1, Th9-Th3, C4-C3:

Stroking is plane, superficial and deep;

Rubbing - semicircular with fingertips and the ulnar edge of the palm;

Shading, planing and sawing;

Kneading - longitudinal shifting, pressing;

Tension and compression;

Continuous vibration, puncturing.

Massage of the latissimus and trapezius muscles:

Stroking, rubbing, kneading, vibration;

Transverse kneading in the direction from bottom to top of the latissimus dorsi muscles in the area of ​​the armpits and supraclavicular edges of the trapezius muscles in the direction from the back of the head to the shoulder joints.

Massage of the sternocleidomastoid muscles:

Pincer-like stroking and kneading;

Puncture and continuous vibration with fingertips;

Puncture and tapping in the area of ​​the VII cervical vertebra.

Massage of the interscapular area and suprascapular areas:

Stroking with fingertips and palm in semicircular directions;

Rubbing with fingertips, supporting surface and ulnar edge of the hand;

Sawing and puncturing with fingertips;

Continuous vibration.

Massage of the supra- and subclavian areas:

Stroking with the pads of the fingers and the ulnar edge of the palm in the direction: from the sternum to the acromioclavicular joints;

Rubbing circularly with fingertips;

Shading and rubbing in the longitudinal direction with the palmar edge of the brush;

Finger puncturing and continuous vibration.

Massage of the acromioclavicular and sternoclavicular joints:

Stroking the palmar surfaces of the fingers in semicircular directions and towards the subclavian and axillary hollows;

Rubbing joint capsules;

Continuous vibration and puncturing in the joint area.

Massage of the pectoralis major and serratus anterior muscles: stroking, rubbing, kneading and vibration.

Massage of intercostal spaces:

Rake-like stroking with fingertips in the direction: from the sternum to the spinal column;

Semicircular rubbing and shading with fingertips;

Rhythmic pressure on the intercostal spaces with fingertips;

Stroking and rubbing the costal arches.

Diaphragm massage: continuous vibration and rhythmic pressure with the palms along the X–XII ribs in the direction from the sternum to the spinal column.

Indirect massage (according to L. A. Kunichev):

Lung areas - continuous vibration and rhythmic pressure over the lung fields from behind and in front.

Areas of the heart:

Continuous vibration of the heart area;

Light, jerky, rhythmic pressure with the palm of the hand above the heart and in the area of ​​the lower third of the sternum.

Chest:

Compression of the chest with the palms along the axillary lines at the level of the V-VI ribs;

Concussion of the chest, compression and stretching of the chest;

Breathing exercises.

The duration of the procedure is 12–18 minutes. The course of treatment is 12 procedures every other day.

At the beginning of the course of treatment, in the first procedures, the front and lateral surfaces of the chest are massaged.

The duration of the massage procedure should not exceed 7–10 minutes.

Gradually, from procedure to procedure, the duration of the massage is increased to 15–20 minutes and the chest is massaged from all sides.

On the intercostal muscles, rake-like stroking and rubbing are used in the direction: from front to back along the intercostal spaces.

When performing spiral rubbing with four fingers, special attention is paid to rubbing the soft tissues in the spine, interscapular area, under the lower angles of the shoulder blades and along their inner edge.

On the back surface of the chest, the techniques of transverse continuous kneading and rolling should be added to the proposed scheme.

On the front surface of the chest, the same massage techniques are used, but with greater force.

Massage technique according to O. F. Kuznetsov

Massage plan: nasal area, nasolabial triangle, anterior surface of the chest, posterior surface of the chest (pillow under the stomach - drainage position).

Massage of the nose and nasolabial triangle. When massaging these areas, a reflex effect occurs on the areas of the upper nasal passages, which affect the absorption of oxygen in the lung tissues. Techniques: stroking, rubbing and continuous labile vibration of the wings of the nose. Duration - 1–1.5 minutes.

Each appointment is carried out 1-2 times.

Rubbing and vibration are carried out quite energetically.

Massage of these areas should not take more than 1–1.5 minutes.

Intensive massage of asymmetrical chest areas (IMAZ)

Indications: bronchitis, pneumonia with an asthmatic component.

The massage begins with impact on the chest muscles; Massage techniques are carried out intensively.

The areas of the anterior and posterior surface of the chest are massaged; Each zone is massaged twice.

The areas of the anterior surface of the chest are massaged for 2.5–3 minutes (bottom - top, bottom - top); duration 12 min.

The areas of the posterior surface of the chest are massaged for 5–6 minutes each (20–25 minutes).

The first massage option is top left, bottom right.

The second massage option is top right, bottom left (Fig. 1).

If pneumonia is localized in the left lower lobe of the segments, choose the 2nd option.

For allergic conditions, an asthmatic component (bronchial asthma, asthmatic bronchitis), it is recommended to start a course of treatment with option 2.

Course treatment - 4–6 procedures. It is more advisable to carry out physical exercises before the massage, since after the procedure it is recommended to warm up and rest for 2 hours.

Massage of the anterior chest

Massage plan: chest, including the abdominal area: on the anterior surface - to the level of the navel, on the posterior surface - to the crests of the iliac bones.

Patient position- lying on your back (the head end of the couch is raised).

A. Thoracoabdominal zone

Planar superficial and deep stroking;

Grinding (shading, sawing, comb-shaped, circular);

Kneading (transverse shift, rolling, circular);

Patting, quilting.

B. Upper zone

The following massage techniques are provided:

Rubbing (linear - with fingertips, palm, circular);

Vibration in the area of ​​the apex of the heart (V intercostal space), in the area of ​​the coracoid process (pectoralis minor muscle), at the attachment point of the pectoralis major muscle;

Kneading (pectoralis major muscle) - longitudinal, shifting, circular.

The massage is completed with intermittent vibration techniques on the lower and upper zones - effleurage and chopping.

Posterior surface of the chest

Patient position - lying on the stomach (pillow under the stomach) - creating a drainage position

A. Lower zone

Massage plan: massage movements are carried out in the direction: from the angle of the scapula to the iliac crest.

The following massage techniques are provided:

Stroking;

Rubbing - streaking, comb-like, sawing (with thumbs paravertebral; circular with weights);

Kneading - transverse, longitudinal, shifting - longitudinal and transverse;

Trituration;

Vibration - a) continuous rake-like (along the VI–IX intercostal spaces) in the direction: from the posterior axillary line to the anterior; b) intermittent - tapping.

B. Upper zone

Massage plan: massage the cervical-occipital region towards the corner of the scapula.

The following massage techniques are provided:

Stroking;

Rubbing (shading, comb-like with the base of the palm);

Kneading (with thumbs) in the interscapular region, in the cervical-occipital region in the direction: from the auricle to the spinal column (circular); shifting the upper portion of the trapezius muscles; longitudinal, transverse along the edges of the latissimus muscle;

intermittent vibration - beating and chopping.

The areas of the back and front surfaces that are subject to massage influences are shaded (Fig. 3).

Rice. 3. Options for intensive massage of asymmetric zones (according to O. F. Kuznetsov): A) first option of intensive massage: hypertrophic zones in the area of ​​projection of the upper lobe of the left lung, middle and lower lobe of the right lung; b) the second version of intensive massage: hypertrophic zones in the area of ​​projection of the upper lobe of the right lung, lower lobe and lingular segment of the left lung

Segmental massage technique

(Glaser O. u. Dalicho A. W.)

Indications for massage:

Changes in connective tissue: occiput (C3), interscapular region (C7-^2), paravertebral muscles (C8-TM0), along the costal arches (Th6-Th10), under the clavicles (C4), sternum area (C5-TM) , left and right of the sternum (Th2-Th1).

Changes in the muscles: splenius capitis muscle (C3), trapezius muscle (C6), rhomboid major (C8-Tn2, Th4-Th5), infraspinatus (C7-Th1), intercostal in the area of ​​the costal arches (Th6-Th9), sternoclavicular - mastoid (C3-C4), pectoralis major (Th2-Th4).

Changes in the periosteum: sternum, ribs, clavicle, scapula.

Maximum (trigger) points: trapezius muscle, under the collarbones, at the edges of the ribs.

Massage plan- the combined effect of various massage techniques on the back and chest area.

For bronchial asthma and pleural adhesions, chest muscle stretching techniques are effective.

Massage techniques should be combined with breathing exercises.

Breathing exercises include exercises in which the components of the respiratory act are regulated voluntarily (according to verbal instructions or commands).

The use of breathing exercises for therapeutic purposes can provide:

Normalization and improvement of the breathing mechanism and mutual coordination of breathing and movements;

Strengthening the respiratory muscles (main and auxiliary);

Improved mobility of the chest and diaphragm;

Stretching the moorings and adhesions in the pleural cavity;

Prevention and elimination of congestion in the lungs; removal of sputum.

Breathing exercises are divided into dynamic and static.

Static exercises include exercises that are not combined with movements of the limbs and torso, as well as exercises with dosed resistance:

a) diaphragmatic breathing with resistance from the hands of a massage therapist (physical therapy methodologist) in the area of ​​the edge of the costal arch closer to the middle of the chest (Fig. 4);

Rice. 4. Diaphragmatic breathing with overcoming the resistance of the hands of a massage therapist (physical therapy methodologist)

Rice. 6. Upper thoracic breathing with overcoming the resistance of the hands of a massage therapist (physical therapy methodologist)

Rice. 5. Diaphragmatic breathing against resistance (sandbag)

Rice. 7. Lower thoracic breathing with overcoming the resistance of the hands of a massage therapist (physical therapy methodologist)

Rice. 8. Upper and mid-thoracic breathing with overcoming the resistance of the hands of a massage therapist (physical therapy methodologist)

b) diaphragmatic breathing with placing a bag of sand of various weights (0.5–1 kg) on ​​the upper quadrant of the abdomen (Fig. 5);

c) upper thoracic bilateral breathing with overcoming the resistance of the massage therapist’s hands in the subclavian region (Fig. 6);

d) lower thoracic breathing with the participation of the diaphragm with resistance from the hands of a massage therapist (physical therapy methodologist) in the area of ​​the lower ribs (Fig. 7);

e) upper thoracic breathing on the right (left) with resistance from the hands of a massage therapist (physical therapy methodologist) in the upper part of the chest (Fig. 8).

Dynamic exercises are those in which breathing is accompanied by various movements of the upper and lower extremities and torso.

The course of treatment is 5–6 procedures.