V-10 Stagnant-ischemic disease of soft tissues in infancy and childhood
According to modern ideas, the formation of pathological processes in an organism, including skeletal muscles, starts in the period of prenatal development of an infant. For example, researches by V.B. Ulsibat and his school (2001) proved that already at an early stage of prenatal development, the embryo responses on the influences of stress factors of external environment with the changes of functions of internals. And as a consequence, it responses with the disorder of metabolism as dystrophy in functioning systems and may even lead to necrosis progression or fetal death. During the growth of the fetus and in different periods of gestation developing dystrophic processes lead to morphological changes due to metabolic disorders (of protein, lipidic, carbohydrate, water-salt metabolisms).
Amino acid metabolism of a fetus is more intensive than in any other period of life. In infancy protein metabolism is also the most vulnerable due to its exceeding tension in realization of plastic function in a child’s organism. Protein metabolism disorder, as a cause of initially appearing dystrophic processes in an organism, is the basis of the concept of system proteinosis development (Ulsibat et al, 2001). In fetal and early postnatal lives, the exceeding progression of connective tissue elements is seen. It is evident as fibrosis. Such processes are most frequently detected in heart, lungs, liver, pancreatic gland, skeletal muscles as “mesenchimoses” (Sharpe et al., 1977).
Disposition to mesenchimoses runs through development of common pathological processes in infants. This is proved by the data about biochemical features of plastic function of connective tissue. Clinically and morphologically, mesenchimoses of extreme degree of manifestation occur as birth defects. Less severe variants are different kinds of cardiopathy, encephalopathy, pneumopathy, nephropathy, myopathy, i.e. the processes, which considerably hinder postnatal adaptation. They are risk factors of chronisation of acute diseases in the following period of life. Researches by E.V. Gridasov (1999) detected occurrence of diffuse dystrophic sclerotic changes in muscular tissue of a fetus and new-borns on the back of pathological pregnancy. For example, 92% of such infants had changes in myocard, 85% of them had pathology of skeletal muscles and diaphragm. The frequency of associated damage of cardiac muscle and skeletal muscles reached approximately 80%.
Capillary-connective structures play a key role in pathogenesis of dystrophic changes. With the change of function of microvessels, taking into account their main role – providing all organs and tissues with plastic and energetic materials, apriori one can expect one or another disorder of tissular metabolism. Indeed, they proved invalidity of microvasculature in premature infants, which was caused by primary deficiency of true capillars (Yarygin et al., 1996). At that, vascular tissular trophic unbalance was detected in all premature infants, and in premature infants of III and IV degree it reached maximum. Morphological immaturity of hemomicrocirculation system in premature infants gives ground to tell about its functional inadequacy, “unpreparedness” for stable support of circulation and metabolic processes in tissues in conditions of extrauterine existence of an infant. Final changes in microvasculature of premature infants are caused by increasing cardiac insufficiency. They are marked by formation of erythrocytic, thrombocytic, leukocytic and combined cellular aggregates with formation of thrombocytofibrinous thrombs in them. Detected changes occur in all links of microvasculature, though in venular link they have the highest degree of manifestation. At that, one can see aggregation of blood cells and blood sludging, feebleness of circulation, adiemorrhysis and venule stasis, necroses of capillars, which are attended with hemorrhages. All this favours blood viscosity increase and disorder of blood perfusion through microvessels. Occurring hypoxia and metabolic disorders in tissues increase and may be irreversible.
Applied materials of researches of the status of microvasculature in premature infants give ground to suppose that at birth of a healthy infant, some regions of infant’s tissues may be marked by deficiency of true capillars, and this will predetermine progression of one or another form of pathology.
Next, postnatal life period is marked by increased frequency of stresses and pathology, connected with deadaptation. For example, in childhood one can see imbalance between age biological abilities of a personality and its socially limited rank of a child. This may lead to severe chronic stress. In this period the frequency of occurrence of stress-associated forms of pathology (neurocirculatory dystony, peptic ulcer disease, hypertensia, obesity and other “stress diseases”) increases. Further formation and progression of loci of dystrophic changes in skeletal muscles and connective tissue occur. Clinically, the loci are evident due to myofascial pains of noninflammatory nature, muscle contractures, MTD of various localization, back bone scoliosis, depression, chronic fatigue syndrome etc. However, specialists, considering children’s complaints about pain of various localization and not detecting any organic pathology during examination, rarely associate appearance of pain, depression and other evidences with pathological changes of skeletal muscles.
In addition to that, palpatory examination of children lets detect muscle indurations, MTD, myofibrilloses in the regions of neck, back and other parts of the body. Our conducted researches detected the presence of painful MTD in more than 90% of both patients and healthy children regardless of their age. Detected MTD are marked by symmetry of localization, pain reproductability. As a rule, they are attended with muscle contractures as myofibrous bands of different linear sizes. Such formations are most frequently located in the region of neck, shoulder girdle, back, pelvic girdle. The cause of appearing of such formations is the disorder of local circulation and associated with it dystrophic changes of skeletal muscles and connective tissue (Zaslavskiy, 1981; Trevell, Simmons, 1989; Ulsibat et al., 2001).
Application of VGT method in clinically healthy and sick children at the age of 3-16 years old allowed to detect a set of common laws in response of tissues to vacuum influence. A group of patients included children with myofascial pain syndrome, fault in posture, scoliosis, obstructive bronchitis, bronchial asthma, consequences of suffered pneumonia, depression, chronic fatigue syndrome, chronic headache and other forms of pathology. During first several VGT procedures, in children of both groups in the regions of neck, back, shoulder joints there occurred the formation of local edema and dermatic extravasates of various intensity of staining. Some extravasates were attended with local puffiness, especially in the regions of localization of muscle indurations and bands. They were sometimes painful; for 3-5 days they were subjected to regression and then disappeared. To the end of course of procedures, the manifestation of dermato-vascular response considerably decreased up to its complete disappearance despite using almost double dose of pressure to compare with the initial one. At that, marked decrease of stiffness of muscle contractures and indurations was seen, they became soft, painless; asymmetry of muscle groups disappeared; restoration of elasticity and other functional properties of tissues occurred. Common health of patients, subjected to VGT influence, considerably improved, pain syndrome decreased and disappeared completely, physical and mental activity considerably increased, immunoprotective mechanisms normalized and it led to decrease of general morbidity rate.
Extravasates and/or local edemas in stress-dependent zones were detected in more than 90% of healthy and sick children regardless of their age, form of pathology, physical development and level of training and also applied ways of treatment and health improvement. Evidences of VILS syndrome in children are mainly located in the regions of neck, back, scapulae, shoulder joints, along the line of osteous processes of vertebrae, in gluteal region, i.e. on stress-dependent areas of the body. Such common laws in manifestation of dermatic vascular response let regard extravasates and local edemas in healthy children as some kind of indicants of latent VILS syndrome.
Uniformity of dermatic vascular response in both groups of children and adults gives ground to suppose that venous interstitial lymphoid stagnation, markers of which are extravasates and local edemas, is one of the key pathogenetic mechanisms of forming of general pathology of a human organism.
Clinical observations prove that in periods of intensive growth of the body particularly marked changes of tissular circulation in skeletal muscles of stress-dependent zones occur. This is indicated by detected with the help of vacuum test extravasates of florid-cyanotic colour, rather painful at palpation. Such extravasates are seen in almost 100% of adults and children at the age of 7-16 years old and older. Puberty age of child’s development is, evidently, some kind of a frontier, which predetermines further formation of SIDST and other visceral pathology in an adult. That is why, this is puberty age when for almost every child, sick or healthy, it is necessary to conduct especially active preventive treatment in order to prevent SIDST formation and other possible form of pathology.
Application of VGT method in children allows to diagnose actively disorders of tissular circulation and at the same time prevent VILS syndrome, providing effective therapeutic influence at very different diseases.
Methods of VGT of children. After manual classic massage on problematic and neighbouring regions of the body, they place simultaneously several vacuum cupping glasses of small sizes. The pressure in cupping glasses is lowered to 13.3 – 26.6 Kpa (100-200 mm of vacuum). The duration of stable decompression on each region is from several seconds to 1-3 minutes. Then, each cupping glass is carefully pressed out from the skin, decreasing the intensity of pressure by 30-50% and without removing them from skin completely, with sliding movements they are moved in the direction of regional lymphoid vessels towards the nearest lymph nodes and backwards with a greater speed. After that, the cupping glasses are removed and replaced on other regions. During one procedure, such manipulations are repeated 3 times, covering problematic and neighbouring regions. According to the age of a child, his/her status and current tasks, after 3-5 procedures the duration of the procedure is gradually increased from 10-20 minutes to 30-50 minutes, and the extent of rarefaction in cupping glasses – up to 250-300 mm of vacuum. The procedure is finished with light stroking movements of hands; the patient is covered with blankets and has rest for 7-10 minutes.
The total duration of the procedure is usually 30-40 minutes, the course – 9-11 procedures 1-2 times a week. As a rule, several first procedures may cause small edematous petechiae (extravasates), local edema, painfulness. It indicates about the presence of VILS syndrome. Later, these evidences disappear and do not repullulate even at greater impacts. It serves as an indicant of normalization of tissular circulation, which is attended with positive clinical dynamics.
V-11 A few aspects of VGT application at an old age
Present ideas about the processes of aging of cellular tissular structures, organs, systems and an organism as a whole, indicate about genetic determinism of this biological phenomenon. On one hand, this does not actually provide any optimal ways to be able to influence life span of a person. On the other hand, a lot of researchers provide a range of more or less convincing evidences, which indicate about the fact that potential abilities of a human organism are not limited with 80-120 years. At least there is no doubt that active and healthy old age is approachable for most people.
To the reasons, which determine the speed of aging of an organism, they refer heredity, nutritional disorder and other features of way of life, pathogenic impact of stress, diseases, environmental pollution and many other factors. Long clinical observations show that pathogenic impact of stress is a negative factor, which has considerable influence on development of aging processes. G. Seliet in his works constantly emphasized on tremendous destructive force of distress, including its activating impact on aging processes. He figuratively reflected it in the following utterance: “Aging is the result of all stresses, to which an organism was subjected during the whole life”. Aging corresponds exhaustion phase of common adaptation syndrome, which in a way represents a short version of natural aging. Any stress, especially caused by fruitless efforts, leading to frustration, leaves behind irreversible “chemical cicatrixes”; their accumulation causes evidences of aging of tissues. The result of stress is “wastage” of an organism, and accumulation of unrecoverable damages on different structural functional levels enhances aging.
Indeed, clinical practice indicates that at early stages of life, people appear to have marked dystrophic changes in soft tissues as multiple connective tissular formations (myofibrillosis) and other pathological transformations. It is written above in this book about pathogenetic mechanisms of tissular pathology. In their basis there is VILS syndrome, ischemia, endothelial insufficiency. As a result, SIDST formation occurs, and it finally leads to disorder of regulatory metabolic processes, dystrophy of tissues and disorder of their functions. We may consider that SIDST is the basis of formation and progression not only of many diseases of skeletal muscles and connective tissue but also of other somatic pathology. Such pathology is some kind of “catalytic agent” of processes of natural aging of an organism. Detected laws in progression of many diseases and aging of an organism are supported by a famous utterance of the patriarch of national gerontology A.A. Bogomolets, who believed that the age of a person is measured by structural functional status of his/her connective tissue. It is also appropriate to remember the words of an outstanding pathologist I.V. Davydovskiy (1969) about the fact that “processes of aging are caused not by the aging of cells, but by the “aging” or deterioration of their environment, where they exist”, in other words – by disorders in the system of microcirculation of cellular tissular elements. More than that, the results of works of a famous Russian physiotherapist A.S. Zalmanov indicate that in the basis of aging processes there is “desiccation of an organism due to gradual closure of capillars, appearance of desiccated cellular islands and retardation of life processes”. It greatly contributed to successful development of a new, at that time, therapeutic area of study – capillarotherapy.
However, in spite of such dramatic events, developing in many soft tissues of an old person and attended with disorders of neuroendocrinal regulation, dislocations of cardio-vascular and other systems, spare capacities of an organism still maintain quite high potential, based on its regenerative-reparative properties. This is especially evident in terms of VGT application in people of an old age. VGT application as an instrument of direct influence on microvasculature of tissues lets diagnose and eliminate pathological stagnant ischemic loci. And this favours optimization of delivery in tissues of oxygen, nutrient materials and normalization of regulatory metabolic processes not only in dystrophically damaged tissues but in the whole organism. The results of VGT application in old people indicate about high effectiveness of vacuum influence. At the very first stages of the course patients start feeling considerable relief in skeletal muscles, accumulated “load of years” disappears, the function of external respiration and mobility in joints normalize, almost all systems of an organism, including its psychoemotional status, normalize. Gradually, after each VGT procedure old patients get the feeling of youth, fit of energy in the organism, normally cold limbs get warmer; consternation and indifference alternate with emerging interest to life.
V-12 Vacuum-gradient therapy of SIDST in sportsmen
As it is known, an organism of a sportsman is constantly subjected to excessive psychological and physical loads. Sports activity is studied as one of powerful stress impacts on an organism. Excessive psychophysical loads may cause premature aging of adaptation mechanisms. It leads to formation of morphofunctional disorders in different organs and systems, which condition the status of pre-existing diseases and pathology.
In this respect, it is necessary to note the important role of chronic psychoemotional and physical distress in occurrence of pathological changes in skeletal muscles and connective tissue. Such changes may induce various disorders of visceral organs. Pathological chain of stress influence is realized by means of vasoconstriction of microvasculature, where one-type intra-, trans- and extravascular disorders develop. As a result of that, one can see feebleness of venular and the arteriole circulation; stagnation regions appear. Occurring CTI syndrome leads to decapillarisation of tissues, causing formation of pain syndrome, local contractures, myofibrillosis and other pathological changes of skeletal muscles.
Conducted by the author clinical examinations of sportsmen of different qualification, including masters of sport and Olympic champions, detected one-type changes in soft tissues of different localization, similar to those that are detected in patients and healthy people, who are not involved in sports activity. For example, VGT application with therapeutic aim in sportsmen, who were patients with various disorders of locomotor system and visceral pathology, and clinically healthy sportsmen was executed. It allowed to detect a range of laws of evidence of dermato-vascular reaction as a response to air influence. During several first procedures with the influence of pressure lowered to 26.6-40 Kpa (200-300 mm of vacuum), they detected typical dermato-vascular response as formation of extravasates with different degree of manifestation. In some cases they are attended with local puffiness and painfulness. More than 90% of patients and clinically healthy sportsmen had extravasates, about 50% had local edemas. Comparative analysis did not detect statistically reliable differences between among examined groups (Drawing 6.2).
Together with that, in some cases they observed clear correlation in sportsmen between maximal manifestation of extravasates and their localization with the intensity of appearance of myofascial pain syndrome; Local edema in sportsmen is usually detected in the places of localization of rough muscle indurations, nodes, posttraumatic injuries of tissues of different limits of time, arthroses of joints.
One-type processes of VILS syndrome formation with the following SIDST progression occurs in both sportsmen and people who do not do sports. Though it seemed that conditions for appearance of stagnant evidences in tissues at physical exercises must be absent. Indeed, in the process of physical training considerable acceleration of circulation in systemic and greater circuits occurs. However, features of functioning of local circulation directly in tissues let them, with a certain extent of independence, regulate the activity of microcirculation processes with the help of physiologically active substrates. It was established that each tissular region has a unique ability to control independently the level of circulation, depending on the degree of tension (Zaychik et al, 1999). As a result, even intensive and regular physical loads are not able to have any considerable influence on effective ‘pumping’ of the system of microcirculation of tissular structures. Apparently, adaptation reserves of this system are not sufficient for compensation of excessive physical training. In favour of this concept there is the prevalence of clinical pathology of soft tissues of locomotor system in sportsmen and people who work physically; the frequency of SIDST evidences in them; finally, the positive effect of VGT on the health of such patients.
Author’s observations and literature data let emphasize a few key factors, favouring tissular VILS syndrome formation and SIDST progression in sportsmen. To such factors they refer:
● Initial functional status of an organism, including genetic predisposition, adaptation abilities of regeneration and resistance to negative factors.
● Chronic overwork of skeletal muscles, micro- and macrotraumatisation of tissues.
● Changes of water-electrolytic balance during physical training.
● Impact of psychoemotional distress.
The complex of listed factors comprises ethiopathogenetic link of VILS syndrome and SIDST in sportsmen. Their result is the considerable decrease of reserve abilities of an organism. That will significantly influence functional-adaptational indicants of sportsmen. As a result, myofascial pain syndromes, immunity disorder, depressive states, increase of morbidity and traumatism occur.
VGT application in sportsmen is aimed at prevention and treatment of stress-associated changes of skeletal muscles and connective tissue, increase of adaptation resources of an organism. It has a serious impact not only on sport results, but also on the general health status. The key principle of VGT procedure in sportsmen does not considerably differ from common recommendations. At that, there are some methodic features of VGT application in sportsmen in different periods of sport activity.
In the period of training for competitions VGT is used in order to normalize psychoemotional and functional status and to prepare tissue of locomotor system for performing the following physical exercises. This favours mobilization of psychophysical mood, acceleration of involving and adaptation of a sportsman to physical exercises, prevention of possible injuries and diseases of locomotor system. VGT procedure is executed, as a rule, in the region of back, and then emphasizes activity on the other parts of the body, which will be under pressure. The duration of the procedure depends on the kind of sport, individual features of an organism of a sportsman and other factors. The procedure is finished 1 hour before the training (competition).
VGT course of 7-9 procedures 2-3 times a week is prescribed during pre-season and also during normal trainings, after suffered injuries and diseases and also in order to increase psychophysical status. The course is finished 2-3 days before competitions.
In recovery period VGT is executed 0.5-5 hours after the competition (training), according to the functional status. The parameters should be non-damaging, and the procedure should be pleasant and painless. VGT application may be regarded as therapeutical procedure and the element of physical training.