At the present time the prevalence rate of diseases in the region of back as an organ, in particular evidences of myofascial pain syndrome, back bone osteochondrosis and related to it neurological disorders, in economically developed countries, according to the data of WHO (World Health Organization), reached the rate of noninfectious epidemic (Shostak, 2003). 8 out of 10 adults suffer from backaches to this or that extent, and for some people it becomes a permanent problem. At that high frequency of invalidization of working-age population is noted due to locomotor system damages. Working losses as a result of recrudescence of myofascial syndrome, including people of young and middle age, are of considerable socioeconomic importance. In this connection one of priority areas, which was recommended by WHO for elaborate study as part of “The Bone and Joint Decade, 2000-2010”, is considered to be myofascial backaches. Though it is necessary to note that myofascial pain syndrome is only “the tip of the iceberg” of all backache problems.
Deep pathomorphological dislocations in tissues of a back (microcirculation disorder, dystrophic processes etc.), which cause pain syndrome formation, remain not enough explored and in point of fact there are no appropriate approaches to their treatment.
The back as an organ
Most people apply to specialists about massage procedure most frequently in the region of back – with various diseases, upsets, pains, heaviness and discomfort in the back, fatigue, depression, psychological overexertion. It seems that people have had a psychological attitude for a long time that the impact on the back region has a favorable impact on the whole organism. Probably tissues of back constantly need regular physical influence? Indeed, only after a few back massage procedures a person feels much better, at that pains decrease, heaviness and discomfort are eliminated, considerable improvement health occurs, vital tonus significantly increases, mental and physical working efficiency improves, psychoemotional balance restores. Specialists should take into account the need for influence on the region of back.
According to modern ideas, nearly everyone during their lifetime suffers pain in the back, pectoral girdle, lumbosacral region etc. In the Western Europe, in the USA and Canada Institutes of Back have been organized and work successfully. This reflects the importance of problems which occur in the region of back. Health problems in the region of back have concerned a huge number of health care professionals since ancient times. This number includes vertebroneurologists, surgeons, traumatologists, orthopedists, masseuses, physiatrists, osteopaths and other specialists. However, the most number of them emphasize their attention mainly on back bone, intervertebral disks, cerebrospinal innervation but do not pay enough attention to the fact that mentioned formations are surrounded with lots of layers of soft tissues, which are washed with extensive net of circulating fluid. Till present there is no proper assessment of significance of functional contribution of pathological changes, which occur in structures of soft tissues of back, to formation of various diseases and pathological conditions.
The formulation of statement about a back as an organ is a kind of attempt to pay specialists’ attention to a particular thing in order to attract attention to solving common strategic task of maintenance and restoration of person’s health. The statement of such a task is predetermined with life itself, constantly appearing health problems and real opportunities to solve the problem of prevention and treatment of many diseases.
Clinical practice constantly demands the search of new approaches to pathology of a back as an organ at different stages of person’s life. Modern data about pathology of a back strongly show that conditions to progression of stagnant-ischemic disease of soft tissues, and it leads to their dystrophy with formation of myofibrilloses and infarctions in different regions of back of children and adults, have been formed since early age (Ulsibat, Mikhailichenko, 2000). These changes with the increase of years considerably progress and become an object of constant attention of patients themselves and specialists of different profile.
Before passing on the argumentation of the concept of a back as an organ, it is necessary to give a terminological definition of an organ. In the “Great Medical Encyclopedia” (1981) organ is described as “...to a certain degree a solitary part of an integral organism which executes some definite specific functions. An organ usually consists of one or several major tissues, with which other tissues are connected. Organ elements may be cells, intercellular substance, blood and lymphoid vessels, nerves. An organ is not only a form of unification of heterogeneous elements on the basis of execution of common function but also a way of their integration. Functional and morphological specifity is typical for every organ. Structure elements of many organs are: stroma, which comprises the soft carcass of an organ, and parenchymatous tissue – a specific tissue of an organ. Stroma consists of cells and fibres of connective tissue, which form bands or sheets, between which there are elements of parenchymatous tissue (muscular tissue in muscles, nerve tissue innerve centres) and also elements of blood-vascular, lymphoid and nervous systems. The unity of stroma and parenchymatous tissue provides the execution of certain functions by an organ. In genesis of an integral organism inner necessary connections and morphofunctional properties of an organ are set such as specifity, reliability, regularity of elements, flexibility etc.”
On the basis of these statements we can study a back as an organ, which is an integral part of an organism.
Back occupies the hindquarter from external occipital protuberance and upper nuchal line to sacroiliac joints, back department of cristae of iliac bones and tail bone at the bottom. The region of back is limited with back subaxillary lines on each side. On the back there are azygous regions – vertebral and sacral regions – and didymous regions – scapular, infrascapular and lumbar regions. The area of back occupies about 18% of all the area of a human body (Walace, 1951) and together with gluteal region this number reaches approximately 25%.
Constitution and function of bones, muscles and other soft tissues of back are well-known. We will emphasize only a few statements, which are particularly interesting for us.
Every intervertebral disk is strongly connected from the top and from the bottom with adjacent disks; moreover they are connected so strongly that in any case can not move, contrary to widespread ideas (Hall, 1998). That is why there are no slipped disks (without common violation of integrity of back bone as a result of serious injury); they are deformed due to disorder of water exchange and tissular circulation in soft tissues, which surround them.
Back does an enormous work mainly of static nature – holding up the position of the body, lifting and holding weights (antigravity function); performs different actions of the body – bending, stretching and rotation; takes part in execution of function of upper and lower limbs. Cerebrospinal innervation has regulatory trophic influence on soft tissues and inner organs; back is a vast receptor field and large myovascular mass.
The only part of the back bone, which is possible to feel with the help of palpation, is a spinous process of vertebra. It is situated rather deeply under the skin surface – approximately 10 mm under the skin of slim people and 50 mm under the skin of stout people. It means that the depth of soft tissues from the skin surface to the centre of the body of vertebra is about 75 mm in a person with normal weight and 130-150 mm in stout people. Back bone joints are situated approximately 50 mm from the skin surface (Hall, 1998).
Bony bodies with ligamentous apparatus of back are covered with multilayer soft tissues such as skin, fasciae and skeletal muscles. A back is provided with strong muscular carcass, muscle groups, which are situated in layers, – interfacial, deep and very deep. They have various functions and provide holding up the position of the body and do a great amount of work of dynamic and especially static nature.
Conducted researches of thickness of soft tissue in the region of lumbar and sacral vertebrae by P.L. Zharkov et al (2001) with the help of computer tomography showed the data, which are presented in table 6.1.
Table 6.1. Thickness (cm) of soft tissues of back from the skin surface to transverse process in lumbar region and in the region of side mass of sacrum (average value and the range of variability) in the region L3-S3 (according to Zharkov et al, 2001).
Skin + cellular tissues
Skin + cellular tissues
Thickness (cm) of soft tissues from the skin surface to transverse processes in lumbar region and in the region of side mass of sacrum consists of thickness of skin, hypodermic fatty tissue, long muscle of back and multifid muscle; in low lumbar region in men it is about 5-7 cm and in women – 5-9 cm and in upper sacral region 2-6 and 2.5-8 cm respectively. It is necessary to note that palpation of bodies and arches of vertebrae is nearly impossible in the lumbar region of back bone and also deep back muscles in lumbar and sacral regions because the mass of hypoderm and interfacial muscles prevents from it.
Blood supply of back is executed by dorsal branches of back intercostal arteries and dorsal branches of lumbar arteries. Blood outflow goes to the veins with the same names. It is necessary to note that in interfacial layers of all skeletal muscles, including muscles of back, vasculature is rarefied in comparison with most internals. This fact promotes progression of dystrophic processes due to anatomic insufficiency of blood supply (Ulsibat, 1993).
Lymphatic fluid outflow goes to lymph nodes, which are situated in opposite regions: in supraclavicular and subclavicular ones on one side and in inguinal region on the other side. In some places (for example in the region of scapula corners) lymphovascular network interlaces greatly and lymphoid flow goes to different directions. According to the data by V.I. Dubrovsky (1993) in back integument there are two opposite flows of lymphoid fluid (from top downward and from bottom upward) in different areas, which are situated one above the other.
Fascial structures penetrate skeletal muscles with hundreds of septa and cover fibres, fascicles, particular parts and groups of muscles.
Used materials clearly indicate about important functional role of tissues of back in life activity of a human and its evident and considerable contribution into common pathology development. Disorders, which occur in a back as an organ, may lead to various pathology of an integral organism. According to Stifvater’s data (1956), a back is a kind of reflexogenic zone of almost all organs. On the back a range of projection zones is found. Projection zones, which were formulated by Abrams (1910), look like small regions 2 cm in diametre, which are situated from both sides of a back bone. He noted the regions, which is in congruence with a sick organ: C1-7 – cervical occipital pain syndromes and esophageal spasms, Th3-6 on the left – pain in heart etc.
The results of clinical observations by R.Lerish (1953) about the status of paravertebral vegetative ganglions should be taken into particular account. His clinical practice showed that in an adult or a teenager it is very hard to find at least one histologically normal vegetative ganglion. In average they were met not more than in 2-3% of cases. But in other ganglions stroma was fibrously transformed as well as their cells. At that neurofagia, chromatolysis, vesiculate edema, hyperpigmentation, diffuse angiomatosis changes, fatty degeneration were observed. Detected dystrophic changes in ganglion cells appeared to be of the same type, which don’t depend on nosological type of disease: stenocardia, hypertension, atherosclerosis, bronchial asthma, obliterating endarteritis, trombophlebitis, dysmenorrhea, colitis etc. One gets the impression that any disease or surgery leaves its trace in paravertebral ganglions. Dystrophic changes in ganglions indicate about various suffered stress situations by a person during his/her lifetime. These situations condition the disorder of local and regional tissular circulation. Similar changes were detected in soft tissues of back of children and adults, patients and healthy people (Trevell, Simmons, 1989; Mikhailichenko, 2000). This indicates about pathogenetic similarity of development of dystrophic processes in tissues and organs, which are conditioned with disorders of microcirculation as a result of stress influence of dystrophic processes in tissues and organs.
Researches by Chenot (1978) discovered that in lymphoid vessels, which are situated along the spine, in exactly certain places there are paravertebral valves, which take part in regulation of microcirculation of every organ. In his opinion as a whole they comprise “the second heart” of an organism. Stagnant evidences in lymphocirculation in the region of this or that valve are pathogenetic factors in occurrence of diseases.
Stress-dependent zones, which are marked by definite laws of occurrence of dermatic-vascular response as extravasates and local edema of tissues as a result of VGT influence, were first discovered by the writer in the region of back. Appearing at that extravasates and local edema reflect the disorder of tissular hemo- and lymphocirculation and microcurrents of interstitial fluid. This was the reason to call such a pathological status of tissular microvasculature – syndrome of venous interstitial lymphoid stagnation (VILS). On the basis of indicants of disorders of tissular microcirculation, clear interrelation between stress influence and VILS syndrome formation was set. VILS syndrome causes a disorder of tissue trophism, which leads to dystrophy, destruction, sclerosis. It seems that these are tissues of stress-dependent zones which are the first to response to stress influence with morphofunctional disorders. Most frequently stress-dependent zones are seen in the top and middle part of back, shoulder girdles, scapular region, on the posterior surface of neck, including hindhead and inions, in the region of mastoids, interscapular region, throughout the length of the line of spinous processes of back bone, in the lumbosacral region, on the posterolateral surface of shoulder girdles, in deltoid muscle region.
The peculiarity of interscapular region is that this is the region where VILS syndrome formation starts, and on the contrary, its decrease and elimination with the help of VGT in comparison with other regions of a back and a body occur in this region after all the others.
In stress-dependent zones of soft tissues of back painful at palpation morphofunctional changes of indurate thick consistency are detected. These changes are marked by indurations, ganglions and bands. Such changes are often associated with evidences of myofascial pain syndrome of various localization. To them we can refer pain in neck, interscapular region, scapular region, region of shoulder girdles, along the line of spinous processes in lumbar, medius and iliac regions of back and sacral part. In the zones of pain syndrome localization there are soft tissues, which are rich with pain receptors, - ligaments, fasciae, tendons of muscles and muscle structures themselves. The areas of attaching them to bony structures, in which dystrophic changes increase with aging, are the zones of the highest risk. It is caused by insufficient vascularisation of such regions and by progressing stagnant-ischemic diseases of soft tissues.
Detected laws of formation in tissues of back of VILS syndrome, which, together with ischemic evidences, leads to dystrophy of tissues, helps regard such pathological processes as stagnant-ischemic disease of soft tissues of back as an organ. SIDST of back includes clinical evidences of diseases, in pathogenesis of which microcirculatory disorders and connected with them dystrophic processes of tissues are the most important. Back bone osteochondrosis with different neurological evidences, herniated disks, radiculitis-ischemia, neuropathies, back bone scoliosis and other widespread diseases can be referred to such processes. It is necessary to note that scientific views of recent years to genesis of back bone osteochondrosis have begun to change considerably, and pathogenetically based ideas start to prevail. At the same time in generally accepted version of chain of pathological processes, which occur at that, there is no logical conclusion. So, P.L. Zharkov et al (2001) treat back bone osteochondrosis as slowly increasing dystrophic changes of intervertebral disk and adjacent vertebral bodies. These changes are nothing else but premature or “well-timed” aging of the back bone. It gives the impression that osteochondrous structures live independently and do not depend on surrounding soft tissues with their wide neurovascular network, which provides trophic influences of all the complex of musculoskeletal system. Actually, as it is seen from the work of the same authors, osteochondrosis falls under pathology, the conception of which can not be fully found in the table 6.2.
Table 6.2. Dystrophic changes of locomotor system (according to: Zharkov, 2003)
Spondylarthrosis (arthrosis of joints of back bone)
Spondylosis (pathological functional reconstruction of growing back bone)
Local functional pathological reconstruction (osteosclerotic, cystoid, transverse)
Asceptic necrosis of bones
Dystrophic changes of sinews and ligaments
Dystrophic changes of muscles
Fixed hyperostosis of back bone (Forrestier syndrome)
with disorders of internals (lungs, heart, kidneys, gastrointestinal tract)
Disorders of microvasculature of soft tissues are significant and often lie in the basis of most part of listed forms of pathology. They can be considered to be the key link in the chain of disorders which lead to intervertebral disks dystrophy and a lot of other pathological changes of locomotor system. The concept of SIDST of back as an organ, which is considered from the point of view of common pathology, helps not only fill in the logical “gap” in conception of pathogenesis of osteochondrosis and disorders, which are connected with it, but also considerably optimize therapeutic measures.
The results of clinical researches indicate about the important role of contribution of soft tissular structures of back to visceral pathology development – diseases of heart, gastrointestinal tract, lungs, liver and other organs and their systems (Proskurin, 1993; Ulsibat, 2001). It is established that pathological changes in skeletal muscles and connective tissue with the help of myovisceral relations induce disorders of functions of internals, and on the contrary, various somatic diseases are attended with pain syndrome in the muscles of back and exit points of intervertebral nerves due to irradiation of pain in damaged organs with occurrence of protective strain of muscle structures. The integration of motor-visceral interrelations occurs because of the following mechanisms: myoreceptors → motor analyzers → nervous vegetative centres → vegetative organs and, on the contrary, interoreceptors of internals → nervous vegetative centres → motor analyzers → skeletal muscles. Disorders of these interrelations lead to various kinds of pathology.
The role of pathological influence of back bone osteochondrosis in formation of visceral disorders, when irritation of roots of cerebrospinal nerves leads internals to the status of readiness for disease, was studied well enough. Long pathological impulsation of damaged tissue of skeletal muscles (VILS syndrome, myofibrillosis, SMFP etc.) first leads to hidden, subclinical and then to evident disorders of vegetative regulation of internals, which result in visceral diseases. SIDST of back, causing formation of back bone osteochondrosis and other diseases of skeletal muscles and connective tissue, clearly has its pathogenic impact on the status of internals. A vicious circle of mutual burdening, stable dominance of pathological impulsation is formed, which strengthens the existence of somatovisceral and viscerosomatic disorders. The mechanism of mutual burdening can be activated with primary progression of SIDST of back as an organ or also with primary pathology of internals. Viscerodystrophic syndromes are referred to the worst somatovisceral damages. As an example, we can think of the following chain of formation of organic somatic disease: SIDST of back (back bone osteochondrosis etc.) → vertebrogenic cardialgia → cardiodystrophic syndrome → ischemic heart disease → (stenocardia, myocardial infarction, cardiosclerosis).
According to localization of vegetative-visceral disorders, there are vertebrogenic, cardial, pulmonic, gastrointestinal, urinogenital and other syndromes, which are marked by appropriate clinical evidences. For instance, in people of middle and especially old age, cardialgia, which is caused by SIDST of back, can go with IHD. SIDST of back in young people may lead to neurocirculatory dystony, neuroses, appearing pain in heart and other vegetative disorders. According to the data by N.I. Bashkirtseva (1977), pathology of cervical spine favours development of coronary insufficiency and deteriorates the course of stenocardia. According to the data of researches by I.B. Gordon (1966), in patients with coronary artery atherosclerosis, osteochondrosis caused not only stenocardia attacks, but also progression of myocardial infarction. Moreover, I.V. Manyakhina et al (1986) note frequently detected parallelism in development of neurological symptoms of cervical osteochondrosis and clinical evidences of ischemic heart disease, and emphasize the interrelation of these processes (table 6.3).
During SIDST of back, which causes dystrophic changes in soft tissues and back bone, long-lasting pathological irritation of vegetative structures with development of myovertebrovisceral disorders occurs, which leads to deterioration and extension of dystrophic changes of cardiac muscle, which are caused by ischemic heart disease. And on the contrary, nociceptive impulsation, coming from ischemic cardiac muscle to lower cervical and upper thoracic vegetative centres, favours formation of neurological evidences of back bone osteochondrosis.
Table 6.3. Differential diagnostics between vertebrogenic cardialgia and ischemic heart disease (according to: Proskurin, 1993; with changes).
Signs of disease
The beginning of attack
Factors, which favour subsiding of pain
Influence of position of the body on intensity and duration of pain
Therapeutic effect of nitroglycerin
Presence of evidences of back bone osteochondrosis
Impact of graduated exercise on veloergometer
Pharmacological probes with isoprenalin and dipiridamol
Effectiveness of treatment with coronarolytics
Influence of treatment of back bone osteochondrosis (physiotherapy) on cardial pain
Influence of manual therapy
Effectiveness of dosated vacuum-gradient therapy
Various (constricting, nagging, aching, pinching, piercing etc.) pains, sometimes with sympathalgia traits
In the region of heart (more frequently in region of its top), more rarely – behind the sternum
Into back, interscapular region, left side of shoulder girdle, often attended with unpleasant feeling in the back bone
Long-lasting (from 15-20 minutes to several hours and days)
Often starts with pains in the left forearm, interscapular region, with lumbago, feeling of heaviness and constraint in the back bone
Sudden movement in the back bone, weight lifting, physical and psychic stress
Relief and relaxation of muscle of back and back bone
Do not influence ECG
Positive effect is noted
Leads to considerable decrease of pain intensity and reduction of cardialgia attacks
Complete recovery is observed
Attacks of constricting or pressing pain, often attended with feeling of fear of death
Most frequently behind the sternum
Into left arm, shoulder, left side of breast, low jaw
Short-term (from 5 to 15-20 minutes)
Gradually increasing pain behind the sternum
Physical and psychic tension, walking, eating, abdominal distention
Quick pain relief
Not connected with disease
Often observed at the moment of attack (depression of ST segment, inversion of deflection T)
Appear clinical and ECG evidences of myocardial ischemia
Cause appearance of evidences of ischemia on ECG
As a rule, quite high
May lead to unstable improvement
Favours stable improvement and prevention of progression of various form of IHD
Used materials show quite an evident role of back as an organ in progression of visceral pathology. On the other hand VGT impact on soft tissues of back leads to considerable medical effects, including normalization of internals activity.
The significance of researches about problems of back is proved by the fact that in the last edition of International classification of diseases a new term was introduced – dorsalgia (like cardialgia) – pain in back when pain syndrome is located in various regions of back (cervicalgia, thoralgia, lumbargia). Dorsalgia is understood as a syndrome of myofascial pains, which are caused by dystrophic and functional changes in tissues of locomotor system (ligaments, fasciae, muscles and their tendons, intervertebral disks, intervertebral joints). There is even another term introduced – “dorsopathy”, when at the same time with dorsalgia pain syndromes in the region of body occur, which are connected with organic disorders of back bone such as radiculopathy, myelopathy, radiculomyelopathy etc. Pathogenic mechanisms of pain syndromes at dorsopathy and dorsalgia are connected with irritation of nocireceptors, which are situated in joint capsules, ligaments, fasciae, muscles and their tendons, in periostal coverage of vertebrae, in external third part of coronary tendons, in walls of arterioles, veins, venules, in vessels of paravertebral muscles; they are also connected with formation of dystrophy loci in skeletal muscles and connective tissue. Interrelation of mentioned changes is a releaser in progression of myofascial pain syndrome.
To summarize everything mentioned above, it is necessary to note that results of author’s own observations and literature data make it possible to consider a back an organ in which, under the influence of stressogenic factors, the following symptoms are formed:
Ÿ Prenosological (prediseased) status of tissues and systems of organs, which leads to high degree of pathological readiness of an organism.
Ÿ Extended stress-dependent zones of microcirculation disorder.
Ÿ A massive “lake” of VILS of biological fluids of an organism.
Ÿ Stagnant-ischemic disease of soft tissues.
Ÿ Big regions of myofibrillosis – dystrophically changed soft tissues of locomotor system.
Ÿ Myofascial pain syndrome.
Ÿ Regions of venous-hemorrhagic infarctions in muscles.
Ÿ Regions of reflected pains of many somatic diseases.
Ÿ So called “critical point” of an organism, which takes part in integration of interrelations of various diseases of psychosomatic and visceral nature (myovisceral and viscerosomatic relations).
And on the contrary, soft tissues of back as an organ take part in realization of highly effective therapeutic impact of VGT method within many diseases and pathological status, favouring normalization of general psychological and somatic health of a person.
A back can be considered to be a central organ of the whole locomotor system, which provides close interrelation of many functional systems, which take part in maintenance of tissular homeostasis of integral organism. Detected laws of evidence of dermatic-vascular response of soft tissues of back to vacuum influence indicate that microvasculature of skeletal muscles and connective tissue of a back as an organ is very sensitive to pathogenic impact of stress influence. As a result, formation of SIDST and progression of somatic and somatopsychic pathology occur, in the first place, in tissues of back. That is why back can be considered to be one of the most vulnerable and damaged organs of a human body.
Thus, the complex of anatomic physiological, pathophysiological features and also the results of clinical researches give ground to regard a back as an organ. Obviously, such a theory promotes integrative way of thinking of various specialists and provides more understandable idea of pathogenic nature of formation of such diseases.
The idea of regarding a back as an organ promotes understanding of the most important role of SIDST of back in progression of clinical evidences of various pathological processes, which are located in the back itself and in the integral organism (Drawing 6.1). But the stumbling block in treatment of microcirculatory disorders at many diseases was an appropriate instrument of pathogenic influence. After the implementation into clinical practice of VGT method, which has a direct influence on microvasculature system, for the first time there appeared a real chance of pathogenetic treatment of SIDST of back and related to it clinical evidences of most diseases of an organism.
Methodic features of VGT of back conduction.
The procedure is started with manual classic massage, which includes techniques of stroking, rubbing, malaxation, vibration, tapping. This promotes, firstly, to adapt tissues to coming, more intensive action, and, secondly, to specify localization of pains, muscular indurations, bands, the nature of dermatic vascular response to the influence etc. Taking into account the presence of two opposite currents of lymph, which are situated one above the other, classic massage must be done in two directions: from top downward and from bottom upward.
After the preparation stage, 5-7 cupping glasses of different size are simultaneously put to problematic and neighboring regions of back. It causes horizontally-vertical gradient of pressures on skin and inside the tissues.
In case of stable influence, including on the line of spinous processes of back bone, several vacuum cupping glasses of different size are set simultaneously. During first procedures rarefaction of air is 26.6-40.0 Kpa (200-300 mm of vacuum), exposition duration – 0.5-1 minute. During following procedures the depth of vacuum is gradually increased in limits of 40-80 Kpa (300-600 mm of vacuum), and in special cases – even to maximum. At that the exposition duration is decreased to several seconds.
During the execution of stable VGT, after the influence on some regions, cupping glasses are pressed out from the skin surface and put on other regions in order to cover as much region of back as possible.
At kinetic action the initial magnitude of rarefaction in cupping glasses is 20-26.6 Kpa (150-200 mm of vacuum). Then cupping glasses are slightly pressed out from the skin surface and move along the massaging regions with turbinal, arcuate and rectilinear movements. Actions are usually made in the direction of regional lymphoid vessels, slowly moving cupping glasses towards the nearest lymph nodes and 2-3 times faster in the opposite direction. The duration of action on each separate region of back is 1-3 minutes. After that cupping glasses are removed and set on other regions. During one procedure pressure on each region in each area is done 3-5 times with maximum range of problematic and neighboring regions of back. Pressure is centered in problematic zones, where pain, myofibrillosis, bands etc are found, and also in the region of neck, scapulae, on posterior surface of shoulder girdle and deltoid muscle, along the line of spinous processes of back bone, in lumbar and gluteal regions. As a rule, emphasis is done during the fourth-fifth and following procedures. The emphasis consists of increase of depth of vacuum and linear sizes of cupping glasses and also in duration of action.
Procedure is finished with stroking; a patient is wrapped and has rest for 5-7 minutes. The total duration of procedure is 30-60 minutes, the course – 11-13 procedures 2-3 times a week. If necessary, the course is repeated in 1-3 months; after stable normalization of status of tissues supporting therapy is recommended (1 procedure once a month).