At the present time there are more and more data that prove the fact that both central and peripheral pathophysiological mechanisms are very important in occurrence of some kinds of tension headache, bilious headache, depression, alopecia areata, skin consumption and other diseases and pathological conditions (Vein et al, 2000).
Among central mechanisms the leading role belongs to neurotransmitter changes and disorder of antinociceptive mechanisms of brain stem. Among peripheral ones functional dislocations of cerebrovascular hemodynamics and dysfunction of soft tissues of scalp are considered to become more and more important. The most widespread is the concept according to which in the basis of tension headache formation there are psychic disorders, which condition dislocations of microcirculation system (ischemia, edema, stagnation) in pericranial muscles, which maintain chronic pain syndrome (Vein et al, 2000).
However, the results of works of other researchers convincingly show that the formation of headache and bilious headache is nearly always connected with irritation of pain receptors in soft tissues, which surround the skull. For example, according to the data by A.S. Zaychik et al (1999), extracranial causes, which cause headache, are conditioned with processes, which are located in sinuses of bones of head, with spasms of ciliary and other muscles, tonic tension of muscles of neck and scalp. It is quite possible that morphofunctional changes of pericranial soft tissues can play a key pathogenetic role in appearance of headaches, bilious headache and other disorders, and they are not postprimary but, on the contrary, primary releasers. This is proved with the results of researches (Trevell, Simmons, 1989; Ulsibat et al, 2001; Mikhailichenko, 2000), which show that in early childhood there occurs formation of painful MTD, muscle indurations in masticatory and temporal muscles and also in the muscles of cervical regions (clavisternomastoid, scalenus). Such changes in soft tissues of head and neck are caused by microcirculatory disorders. For example, at alopecia areata and some other kinds of pathology of hair microcirculatory dislocations of vasculature of capillary and reticular dermis are detected. Detected changes are the result of sudden spasm of microvessels, which is connected with endothelium dysfunction. At that one can see feebleness of circulation, marked hemorheological and hemostatic changes, and it leads to disorders of trophism of hair follicles and surrounding tissues (Ponomarenko et al, 2001). And with it, as a result of conducted by the author diagnostic and treatment tests with the help of VGT of healthy people and patients with various pathologies in soft tissues of head, zones of VILS syndrome were detected. Evidences of venous-interstitial-lymphoid stagnation were most frequently detected in tissues of cervico-occipital, frontal, temporal and facial regions (Mikhailichenko, 2002).
Introduced materials and results of clinical observations give ground to suppose that in pericranial tissues of head as well as in other parts of investing tissues of the body, since early age morphofunctional dislocations occur (ischemia, VILS syndrome, dystrophy), which lead to formation of stagnant-ischemic disease of soft tissues of head (SIDST). Clinical reflection of SIDST as a more common category of tissues pathology is its particular components: tension headache, bilious headache, depression, alopecia areata, skin consumption etc. At that, the role of morphofunctional changes of pericranial soft tissues in occurrence of different kinds of pathology becomes more evident.
Modern pharmacological industry offers quite a large range of tools and approaches to solving considered problems. However, as long author’s experience and literature data show, none of the tools or their combination are able to influence considerably fundamental processes of pathology in tissues, and in some cases they cause unfavourable and even harmful side effects. More than that overuse of medications leads to transformation of episodic problems into chronic ones (Vein et al, 2000). In this respect the method of direct influence on the key part of pathology – microcirculatory disorders seems to be quite perspective and highly effective instrument of syndrome-pathogenetic therapy of SIDST of head. Using gradual VGT leads to considerable decrease and elimination of pain syndrome, provides normalization of functions of microvasculature of interfacial and deep layers of tissues. Microvasculature favours correction of regulatory metabolic processes and maintenance of homeostasis of functional systems of an organism.
Methodic features of VGT of scalp. At the beginning of the procedure there is a preparation stage, which consists of manual massage of scalp. The patient is in seated or reclining position with his/her eyes closed. The massage is done rhythmically, with slow speed; fingers are positioned very close to roots of hair. Basic techniques of classic massage are used: stroking, rubbing, malaxation, vibration, rhythmic jerking of tufts of hair with hands. Massage is started in the region of forehead, from the place of attachment of epicranial muscle. After the preparation stage on the scalp (in the head centre, on the line of hair growth and in the region of hindhead or temporal cavities) 1-3 cupping glasses of small size are set, which are attached to a vacuum machine. At the first stage rarefaction of air in cupping glasses is not less than 200 mm of vacuum (26.6 Kpa). Pressure of sides of cupping glasses on skin must not be painful. One of the cupping glasses is taken with the right hand and moved without pressing them out from the skin surface while the left hand is fixing the head of the patient. Movements are made along sagital parts from the hindhead towards the forehead and backward, along radial parts from the centre of the head towards ear auricles and backward on the right and left sides of head. Movement of the cupping glass is made in one direction 3-5 times with the fixation of the cupping glass in the region of inions of mastoids. After that next cupping glass is moved in spiral or wave-like way with the maximum of coverage of the head surface.
During movement of the cupping glass, the skin is fixed by turns with the fingers of right and left hands in order to prevent the skin from moving together with the cupping glass. Then the same movements are repeated with other cupping glasses, blanketing frontal region, superciliary arches, bridge of the nose, temporal cavities. The duration of impact on each separate region of the head surface is from several seconds to three minutes. The intensity of pressure on tissues of the head is gradually increased with every next procedure. For prevention of appearance of extravasates movement of cupping glasses is made quite fast and energetically. After removing of cupping glasses the procedure is finished with slight stroking movements and gentle pressure of IV-V fingers on eyeballs, fixing them for 1-2 minutes.
The total duration of the procedure is 13-15 minutes, the course of treatment – 9-11 procedures, daily or every second day. If necessary, the same course is done in 3-4 weeks. The pressure on the scalp must be combined with vacuum-therapy of cervical region and back, which considerably increases the medical effectiveness of VGT.
Indications: chronic psychoemotional stress and stress-associated diseases, chronic tension headache, bilious headache, hypertensive disease of I-II stages, dizziness, insomnia, chronic fatigue syndrome, vertebrobasilar insufficiency, defective memory, neurocirculatory dystonia, impairment of eyesight and hearing, auditory inefficiency, disorder of function of oil and perspiratory glands, loss of hair, alopecia areata.
V-3 Vacuum-gradient therapy of SIDST of neck
SIDST of posterior surface of neck includes well-known in clinical practice syndromes of vertebrogenic and extravertebral origin such as cervical osteochondrosis and its syndromes, reflectory-muscle compression syndrome, anterior scalene muscle syndrome (Naffziger), compression-radicular cervical syndromes, irritative-reflectory syndromes (painful – cervicalgia, cervicocranialgia, cervicobrachialgia), muscle-tonic syndromes – syndrome of inferior oblique muscle of head, syndrome of muscle, which lifts scapula, local muscle spasms and other pathological conditions.
Clinical picture of given list of syndromes is quite well illustrated in neurology handbooks. It is necessary to note only a few evidences of this picture, which are marked by myofascial pain syndrome, function disorder, depression and other evidences, which are definitive for SIDST. Pathogenetic basis of listed syndromes consists of microcirculatory disorders in respective regions of tissues, which lead to progression of dystrophic processes in them.
Significant examples of peculiarities of clinical evidence of SIDST of cervical region are syndrome of vertebral artery and vertebral-basilar insufficiency. Clinically we can differentiate functional and organic stages of syndrome of vertebral artery or vertebral-basilar insufficiency. In the basis of pathology there is a spasm or compression of vertebral artery.
Functional stage of syndrome of vertebral artery is marked by headache with concomitant vegetative disorders, cohleovestibular and visual disorders. Throbbing, nagging, burning, persistent and colicky, especially when moving head, pain in the head usually spreads from occipital to frontal regions (symptom of taking off helmet). Skin of the head is often painful even at slight touch, combing hair. Pain increases at pressure and especially at tapping in the point of vertebral artery. Cohleovestibular disorders occur as paroxysmal non-systemic giddiness (feeling of imbalance, rocking) or systematic giddiness. They may combine with the noise in ears, a little decrease of hearing. Visual disorders are marked by darkening of vision, feeling of sand, sparkles and other photopsies, insignificant changes of tonus of vessels of eyeground.
During long and intensive vascular disorders loci of stagnant ischemia develop. These loci are the organic stage of vertebral artery syndrome. The artery is marked by transient and long-term disorders of circulation in brain and spinal cord. Transient disorders in vertebrobasilar system are of one type as well as neurovertebrogenic disorders: short-term ataxy, nausea, disarticulation and other disorders of function of IX-X cerebral nerves. Moreover there are some kinds of transient cerebral ischemia, which are most frequently seen at vertebrogenic damages of vertebral artery. They often occur at the moment of turning or bending of the head. These are the drop attacks while being conscious and attacks of fainting nature (syncopal). The former last 1-2 minutes, the latter are longer. After the attack, weakness, headaches, noise in ears, photopsy and marked vegetative lability are seen. Such attacks are caused by paroxysmal ischemia of brainstem, reticular formation (at syncopal attacks), zones of pyramidal decussation (at drop attacks). At stable disorders of circulation in vertebrobasilar system, symptoms of stem and cerebellar pathology may last more than 24 hours.
Long clinical practice showed quite high effectiveness of vacuum-gradient therapy at vertebral artery syndrome. In treatment of SIDST of cervical region syndromic-pathogenetic and clinical functional approaches are used.
VGT goal is reduction of myofascial pain syndrome, eradication of muscle-vascular spasm, elimination of VILS syndrome in tissues of cervical region, regeneration of the damaged function.
Technique of using VGT on the neck. The position of the patient is sitting or lying on the stomach. First preparation stage is executed with the help of manual techniques of classic massage. This helps relax muscles and get some extra information about the presence of trigger dots, muscle indurations, bands etc. After the preparation stage on posterior and posterolateral surfaces of neck they set 1-2 vacuum cupping glasses of congruent shape, which are attached with the help of air offtakes to vacuum machine. Initially, the rarefaction of air is 26.6 Kpa (200 of vacuum). The duration of stable pressure on every region of the neck surface is from several seconds to 1 minute. Then the cupping glasses are removed from the skin surface one by one and placed on other regions in order to have some influence on pilary part of occipital region, mastoid processes and along the whole surface of neck. During the following procedures the level of vacuum is increased up to 40-53.3 Kpa (300-400 mm of vacuum) and at the same time the duration of the pressure is decreased to several seconds. VGT emphasis is made on problematic regions of neck (the regions with indurations, bands, pain) by means of longer exposition and increase of depth of vacuum. The procedure is finished with slight stroking movements.
The total duration of the procedure is 10-15 minutes, the course of treatment – 9-11 procedures, daily or once every two days 2-3 days a week. If necessary, the repeated course is done in 1-3 months. Vacuum-gradient therapy of neck is usually executed combined with the influence in the regions of back and head.
As a rule, after the first 1-5 VGT procedures on the surface of neck one can see strongly marked dermato-vascular response in the shape of formed extravasates (petechiae). Hemorrhages can be marked with various degrees of intensity; they sometimes combine with marked local puffiness. It gives evidence about the presence of VILS syndrome. During the execution of the following VGT procedures (with the increase of rates of influence) one can see gradual decrease of degree of manifestation of indicants of dermato-vascular response even to complete disappearance of dermatic extravasates and local edemas. Taking into account positive clinical dynamics and the absence of hemorrhages, we can tell about the restorative processes of microvasculature of tissues and normalization of its trophism.
V-4 Vacuum-gradient therapy of SIDST of gluteal region
The lower limb of a human, as an organ of support and movement, has strong musculature, which contains more than 50% of total mass of muscles in the human body. Soft tissues of gluteal region include several muscle layers, interfascial cellular spaces, synovial bursae and ligaments. The skin of gluteal region is connected with interfacial fascia by multiple connective tissular bands. And as a consequence, hypoderm has cellular construction. Between the folia of interfacial fascia there is an adipose cushion; between the deep folium of interfacial fascia and muscle fascia there is an adipose layer, which goes into lumbar region. Such a construction of gluteal region favours formation of stagnant-ischemic disease and cellulite. SIDST, in the basis of which there lay disorders of local microhemodynamics, causes occurrence of dystrophic processes in gluteal region. In the projection of localization of local pain syndrome there are ligaments, muscles, their fasciae and tendons, extended tree of blood vessels, all of them full of pain receptors. This causes the occurrence of myofascial pain syndrome. Stagnant-ischemic evidences lead to progression of infarctions of gluteus muscles. The progression leads to dystrophic process, on the basis of which there occurs the formation of cicatrical fibrous indurations, bands and nodes.
Clinically, SIDST of gluteal region is marked by: pain syndrome of various localization; dermatic extravasates and local edemas, which are detected with the help of VGT; fibrous nodes, indurations, bands, which are painful at palpation; function disorder. Such morphofunctional changes in tissues of gluteal region lead to clinical evidences – piriform muscle syndrome, compression ischemic syndrome and other diseases.
Methodic features of VGT procedure of gluteal region. The procedure is usually executed simultaneously with the influence in the regions of back and head. Corresponding emphasis is made on gluteal region and gluteal fold. At that, prolonged stable pressure is made with several vacuum cupping glasses with the duration up to 5-10 minutes with the following replacement. Initially, the pressure in cupping glasses is lowered up to 26.6-40 Kpa (200-300 mm of vacuum), then to 53.3 Kpa (400 mm of vacuum) and more, even to maximum. The most accurate vacuuming must be made in projections of localization of pain syndrome, marked fibrous indurations, bands. As a rule, mainly static vacuum therapy is executed in these localizations. The special feature of gluteal region is that the VGT procedure causes extravasates occurrence not in all cases. It mainly may be conditioned with large thickness of subcutaneous fat. That is why extravasates may occur after 3-5 VGT procedures.
The total duration of the procedure is 10-13 minutes, the course – 11-13 procedures 2-3 times a week; the repeated course is executed in 1-3 months.
V-5 Vacuum-gradient therapy of SIDST of lower limbs
SIDST of lower limbs is associated with most diseases of locomotor system, which are connected with disorders of hemo- and lymphodynamics and lead to dystrophic changes in thighs, shins, feet. In clinical medicine such diseases are regarded as muscle pain syndromes, compression ischemic neuropathy of sciatic, tibial and fibular nerves, tunnel syndrome of tarsal region, obliterating endarteritis, arthroses, posttraumatic changes in joints etc. Clinical pictures of the listed diseases are described quite well in corresponding manuals. In most of them the authors place the main emphasis on ischemic genesis of one or another nosological form.
At the same time, they stated that in pathogenesis of tissular disorders of lower limbs, as well as on other regions of the body, there may be not only ischemic component of disorders but also evidences of venous hyperemia (VILS syndrome) or their combination. VILS syndrome is especially typical for tissues of thigh, knee joint region and upper part of shin and much less typical for lower part of shin, ankle-joint and foot. However, as it is known, ischemia and venous blood stagnation lead to one-type consequences – progression of dystrophic changes, which cause occurrence of various forms of diseases. That is why at many diseases of lower limbs VGT application is pathogenetically approved. Its action is used for normalization of disorders of tissular hemo- and lymphocirculation, which causes reconstructive regenerative influence on dystrophically damaged tissues.
Methodic features of carrying out the VGT procedure of lower limbs. The procedure is carried out after preparative manual classic massage, which includes techniques of stroking, malaxation, rubbing, vibration, tapping. After the preparative stage several vacuum cupping glasses of various linear sizes are simultaneously placed on posterolateral region of thighs, shin and foot. It creates horizontally-vertical gradient of pressures in skin and underlying tissues. Originally, the range of lowering of pressure is 26.6-40 Kpa (200-300 mm of vacuum), and the duration of stable influence on each region is 3-5 minutes. After that, all the cupping glasses are slightly pressed out from the skin surface, decreasing the force of influence by 30-50% and without pressing them out completely. Then, with sliding movements, they are moved along the skin surface in the direction of regional lymphoid vessels towards the nearest lymph nodes and backwards. Then, the cupping glasses are removed and set on other regions in order to cover as much area of frontal, external and posterior surfaces of leg as possible.
According to stable methods, several congruent cupping glasses of different sizes are simultaneously placed on both legs. Rarefaction of air inside the glasses is set in limits of 40-53.3 Kpa (300-400 mm of vacuum) with gradual increase during the following procedures up to 66.6 Kpa (500 mm of vacuum) and more. At the same time the duration of influence is increased up to 7-10 minutes. It is necessary to note that the dose and the time of influence depend on current tasks and the status of the patient. In case of hypersensitivity the degree of rarefaction in cupping glasses must be decreased and the duration of influence must be increased. It is especially important for posterolateral surface of shin, plantar surface and the back of foot, gluteal fold.
On the frontal surface of thighs and in the region of knee joints the rarefaction of air is used in limits of 20-26 Kpa (150-200 of vacuum), the duration of influence on each region is 1-3 minutes with gradual increase during the following procedures. The application of vacuum therapy on the interior surface of thigh is usually not recommended, as well as during classic massage. Though in some cases vacuum therapy can be used only with regimen of moderation. During the influence on the ankle-joint and the back of foot, the pressure is increased up to 40 Kpa (300 mm of vacuum) and more, the duration of influence on the surface of this region is increased up to 10 minutes. At that, the influence must not be painful. The procedure is finished with stroking; a patient is covered with blankets and has rest for 5-7 minutes.
The total duration of the procedure is 1 hour, the course – 11-13 procedures 2-3 times a week. If necessary, the course is repeated in 1-2 months. The procedure on lower limbs is executed, as a rule, at the same time with the influence on the regions of back, buttocks and head.
V-6 Vacuum-gradient therapy of SIDST of shoulder girdle and upper limbs
Disorders of microvasculature of tissues, which also cause disorders of peripheral nerves, form the basis of pathogenesis of many diseases of shoulder girdle and arms. SIDST is the pathogenetic nature of such dislocations. It leads to dystrophic changes in tissues. SIDST is associated with humperoscapular pain syndrome, humperoscapular periarthrosis, tunnel neuropathy of arms, compression ischemic neuropathy of shoulder girdle and arms, arthrosis of joints and other diseases, in the basis of pathogenesis of which there lay disorders of hemo- and lymphocirculation.
Clinically, SIDST of upper limb is marked by occurrence of myofascial pain syndrome, disorder of function of various degrees of manifestation, vegetovascular dislocations, stagnant ischemic processes. The latter are detected at the influence of vacuum in the region of posterior and interior surfaces of shoulder girdle, scapula, upper third part of shoulder, brachioradial muscle and in particular cases in the region of wrist joint and the back of wrist. The occurrence of extravasates with marked puffiness after the execution of vacuum diagnostic test is more frequently detected in persons, whose jobs are closely connected with hard physical activity.
VGT goals are: decrease and elimination of pain syndrome, restoration of damaged tissular microvasculature and dystrophically changed tissues. It is necessary to note that prediction of speed of restorative processes in such cases mainly depends on individual properties of tissues and the degree of damage.
Methodic features of VGT procedure of upper limbs. As a rule, VGT procedure of arms is executed simultaneously with the influence on the regions of back, neck and head. On arms stable methodics of VGT procedure is mostly used. After preparative manual classic massage of arms, in the regions of shoulder joint, shoulder, forearm and the back of wrist, they place simultaneously several congruent cupping glasses of different sizes, which are attached to the vacuum machine. Initially the rarefaction of air is 26.6-40 Kpa (200-300 mm of vacuum), the duration of influence on each region is 0.5-1 minute. Then the cupping glasses are successively replaced in order to cover as much as the surface of limbs as possible. The most thorough influence is executed in the region of muscle indurations, pain syndrome etc. For that, with every following procedure, the degree of rarefaction is increased by 10-30% up to maximum, and the duration of influence on each region is up to 3-5 minutes. The procedure is finished with stroking and shaking arms. The duration of the procedure is 15-20 minutes; the course – 11-13 procedures 2-3 times a week. If necessary, the course is repeated in a month.
V-7 Vacuum-gradient therapy of SIDST of frontal thoracic wall
In classic massage this part of the body gets undeservingly little attention due to methodic difficulties. Meanwhile, patients quite often complain about the pain in the region of chest with irradiation to the region of heart, armpit, left arm. At that, patients feel discomfort, constraint, which may get worse at stress influence, cough, sneezing etc.
Evidences of pain, which are located in the region of frontal thoracic wall and not connected with diseases of cardiovascular system, are regarded as “pectalgic syndrome” (Bogoyavlenskiy et al, 1982). The most frequent reason for pectalgic syndrome is cervicothoracic osteochondrosis of back bone (Khabirov, 1989). In literature this syndrome is also known as cardial syndrome, which occurs at osteochondrosis of cervical and thoracic parts of back bone.
The main complaint of patients is pain of nagging and dull nature, of various intensity and duration. Such pain is usually located in the left half of frontal thoracic wall or in parasternal regions, more frequently on the left. The pains are constant and get worse at quick turning of head, body, strong cough, weight lifting. Some patients note occurrence and increase of pain in the region of heart during lying on the left side of the body, which often leads to insomnia. Almost all patients regard such pains as cardial ones, however, they are not reserved with the help of antianginal and other cardial medications. It may lead to psychic asthenisation. Combination and layering of pectalgic syndrome with IHD and other heart diseases often happens. It considerably complicates diagnostics and choice of the appropriate therapy. In this respect, it is necessary to carry out differential diagnostics with the use of ECG, roentgenologic research, palpatory examination of soft tissues.
Palpation of soft tissues of frontal thoracic wall at pectalgic syndrome detects local painful areas, indurations of different linear sizes and shapes, mainly in the projection of greater pectoral muscle on the left, more rarely on the right. As a rule, trigger zones coincide with the projection of subjective sense of pain. Palpation of such formations may sometimes lead to increase of cardialgia.
Pathomorphologically, pectalgic syndrome is marked by dystrophic changes in tissues, which are caused by microvasculature disorders. This is indicated by extravasates, which are detected with the help of VGT. These extravasates in most cases coincide with the projection of trigger dots. It gives ground to tell about formation of SIDST of frontal thoracic wall, which is evident as pain syndrome and other disorders. It is quite evident that SIDST of frontal thoracic wall may lead not only to pectalgic syndrome formation but to progression of another form of pathology, for example: smaller pectoral muscle syndrome, mastopathy, Titze syndrome and other dystrophic processes. Using VGT in this region leads to relief of pain syndrome and elimination of stagnant ischemic processes in tissues.
Clinical observations of the author show that SIDST evidences are detected not only in patients, but in almost every clinically healthy person, though pain evidences may be absent. For detection of primary evidences of SIDST it is sometimes enough to execute palpation of region of chest and vacuum test.
Methodic features of VGT of frontal thoracic wall. After the preparative manual massage several vacuum cupping glasses of different sizes are simultaneously placed on the regions of greater pectoral muscle, breastbone and sterno-costal joint. Pressure lowering in cupping glasses is 13.3-26.6 Kpa (100-200 mm of vacuum). The duration of stable decompression on each region of the surface of thoracic cage is from several seconds to 1 minute. Then cupping glasses are carefully pressed out from the skin surface, lowering the intensity of pressure by 30-50%, and with sliding movements they are moved in the direction of regional lymphoid vessels towards the nearest lymph nodes and, faster, to the original position. The pressure is emphasized in the region of sterno-costal ligament and greater pectoral muscle, in the projection of pain syndrome localization and muscle connective tissular indurations, bands, nodes etc. After that, the cupping glasses are removed and placed again on other regions. During one procedure, such manipulations are repeated 3-5 times, covering problematic and neighbouring areas of tissues. During the following procedures (usually after the third one), the intensity of decompression is increased up to 250-300 mm of vacuum, and the duration of pressure on each region – up to 3-5 minutes.
It is necessary to note that several first VGT procedures are rather painful, that is why it is better to apply not so intensive pressure and to carry out procedures more rarely than at the influence on less sensitive areas of skin, 1-2 times a week. VGT procedure on the frontal thoracic wall is usually executed simultaneously with the influence on the regions of back, head and abdomen. The duration of the procedure is 10-15 minutes, the course – 9-11 procedures.
It is forbidden to place vacuum cupping glasses directly in the regions of heart, nipples and (in women) milk glands.
V-8 Vacuum-gradient therapy of SIDST in abdominal region
SIDST in the region of abdomen is marked by abdominal syndrome, in the basis of which there are dystrophic changes in muscles of frontal abdominal wall. There are three clinical variants of abdominalgia: thoracic, lumbar, thoracolumbar. Thoracic variant is marked by aches in upper and middle parts of frontal abdominal wall. At that, myofascial trigger dots are detected in rectus and oblique muscles of abdomen, mainly at epigastrium and mesogastrium levels. Lumbar variant is marked by aches in the lower part of abdomen; dystrophic changes are located in ilioinguinal, suprapubic and umbilical regions. Patients with thoracolumabar variant suffer from diffuse, extended aches in various regions of frontal abdominal wall, which are attended with unclear vegetative disorders (nausea, urinary discomfort, diarrhea). The course of this variant of abdominalgia is marked by more frequent and long-lasting recrudescence to compare with thoracic and lumbar variants.
Local hypertonuses of muscles and zones of dystrophy are multiple, as a rule, and they are detected in various abdominal muscles. The most painful areas of indurations are located in the upper part of rectus muscles of abdomen, especially at the inner part of costal arch, in umbilical region and in the place of attachment of muscles to the pubic crest. Zones of dystrophy are usually located symmetrically, though clinical evidences may be marked from one side more clearly. Damage of oblique muscles of abdomen is mainly one-sided, more frequently on the right. Disorder of functioning of abdomen muscles leads to progression of pathology of locomotor system and organs of abdominal region. Depression of tonus and strength of frontal abdominal wall leads to stagnant evidences in organs of abdominal region and causes progression of various pathology and functional disorders.
Using vacuum test in the region of frontal abdominal wall detects the regions of tissues with stagnant venous hyperemia, more frequently on the right.
Methodic features of VGT of abdominal region. It starts with the preparation stage, using techniques of classic massage – stroking, traversing, malaxation, vibration. Movements are made clockwise around the belly-button. Then on the area of stomach 5-7 vacuum cupping glasses of various linear sizes are set simultaneously. First the pressure in cupping glasses is lowered to 20-26.6 Kpa (150-200 mm of vacuum), duration of static influence on each zone is about 1-5 minutes. Then, each cupping glass is slightly pressed out from the skin surface, lowering the strength of influence by 30-50%, and without removing them from the skin, the cupping glasses are moved with sliding movements along the massaged regions in the direction of regional lymphoid vessels towards the nearest lymph nodes and then faster to the original position. During one procedure, such manipulations are done 3-5 times on each region, covering problematic and neighbouring areas. At that, the influence is emphasized on problematic regions: massive fat deposit, cellulites, cicatrical changes of skin, muscle indurations, in the regions of pain syndrome localization. After that, the cupping glasses are removed, and the procedure is finished with light stroking movements. During the following procedures, the rarefaction is increased to 40 Kpa (300 mm of vacuum), and the total duration of the procedure – to 30 minutes. The total duration of the procedure is usually 10-15 minutes, the course consists of 9-11 procedures, 2-3 times a week. The repeated course is done in 1-2 months.
VGT procedure is combined with the influence on other parts of the body according to the plan: back – stomach – chest – head, emphasizing the influence on the back and in the region of frontal abdominal wall.