Rukhadze Manana
Hippotherapy (Ridetherapy) in Prevention of Neurological Syndromes of
Osteochondrose of Spine
State Medical Academy of Georgia. Department of Therapeutic Gymnastics,
Sports Medicine and Ridetherapy
We have been carrying out physical rehabilitation of patients with
osteochondrose
of spine since 1988. Results of physical rehabilitation of those
patients who underwent ridetherapy both independently and in combination with other
methods of physical rehabilitation were presented by us as fragment at the Tenth
International Congress of Ridetherapy in Anger in 2000.
At present, we’d like to present results of 3 months intensive course and a year
of preventive measures, i.e. effectiveness of secondary prevention, and also stable
character
of obtained results followed up for 3 and 5 years after secondary
prevention.
340 patients of both sexes (160 women and 180 men), 26 - 62 years of age
with reflex and reflex-compressive syndromes of spinal osteochondrose in subacute
and remission phases were investigated. They were grouped according to localization:
103 patients with mainly neck osteochondrose, 80 – with thorax localization and 157
30%
46%
24%
nech
– with waist localization (Fig 1).
thoraxe
waist
Fig. 1.
Namber patients of localization
Neck osteochondrose involves following syndromes: (Fig. 2, 3, 4, 5), thoracic
osteochondrose – (Fig.6) and lumbar osteochondrose – (Fig.7, 8).
12%
4%
30%
39%
15%
Cervicalgia
Syndromes of oblique muscle
Syndromes of auricle likestairs muscle
Syndromes of shoulderblade lifting
Cervico-spondiloarthrosis
Fig 2.
Clinical syndromes of osteochondrose of neck Reflex syndromes
38%
62%
Sclerotomycal cervicocranialycal
Vertebral column artery's or neck's back simpathetyc syndrmes
Fig. 3. Clinical syndromes of osteochondrose of neck reflex cranialycal syndromes
37%
56%
7%
Syndromes of chest's little muscle
Shoulder peryarthrosis
Syndromes `shoulder-han
Fig. 4. Clinical syndromes of osteochondrose of neck Brachialgial reflex
syndromes
15%
45%
22%
11%
7%
C4
C5
C6
C7
C8
Fig. 5. Clinical syndromes of osteochondrose of neck Compressely rooted syndromes
15%
85%
dorsalgia
peqtalgia
sometimes with vegetal decree abolishment
Fig. 6. General and clinical date of sickes with breast osteochondrose Clinical
reflex syndromes
3%
12%
22%
7%
18%
20%
lumbalgia
18%
coxcalgia
Syndromes of pear muscle
pear undermuscle pudendneuropathia
Underknee syndromes
Vazospasmus form of sisxlZarRvovani dystonia
Vasodilation form of sisxlZarRvovani dystonia
Fig. 7. Clinical characteristic sickes with loins osteochondrose Reflex
syndromes
6%
4%
45%
45%
L3
root's
L
4
root's
L
5
root's
L
6
root's
Fig. 8. Clinical characteristic sickes with loins osteochondrose Compressely
syndromes
General clinical data, in particular, subjective and objective parameters, tests
revealing muscular tone and strength function, X-ray and magnetic nuclear imaging
data were collected and created basis for therapeutic gymnastics modified by us and
ridetherapy methods elaborated by us (1993, 1999, 1999,2000).
Tests were carried out before treatment, in three months – in order to find out
rehabilitation effect and a year after – to reveal secondary prevention effect. Case
history data: duration of the disease, stage, frequency and duration of relapses, clinical
picture and remission type were studied to find out treatment effect stability after
three and five years of physical rehabilitation.
The patients were divided into three groups: I – basic group, 195 patients who
had stage by stage physical rehabilitation: physical therapy, massage and therapeutic
gymnastics; Ridetherapy was added after 3-4 weeks; II – basic group, 50 patients who
had physical rehabilitation only by ridetherapy; III – control group, 95 patients treated
according to traditional methods: physical therapy, massage and therapeutic
gymnastics procedures. They underwent intensive physical rehabilitation during three
months period and afterwards followed our recommendations: in particular, I group
patients did special exercises at home every day and on horse – once a week for 45-60
minutes. II group patients did exercises on horse independently 1-2 times a week for
60-90 minutes. III group patients had special therapeutic exercises every day at home.
In cases of neck and thoracic osteochondrose in basic (I and II) groups
positive dynamics of subjective data continued, and in case of lumbar osteochondrose
achieved therapeutic effect was maintained. At the same time complaints rose in the
III – control group.
Thus, based on subjective data, secondary prevention carried out complexly –
by means of ridetherapy and special exercises, or by ridetherapy alone hampers
disease progression that is hardly seen using only special exercises.
Objective tests dynamics shows that in I an II group patients with neck
osteochondrose therapeutic effect achieved after treatment was kept, and in the I
group were ridetherapy and therapeutic gymnastics continued, muscular system status
improved. Similar results were manifested in case of lumbar osteochondrose. In
patients with reflex syndrome of lumbar osteochondrose, results are significantly
higher for the II group as compared with the III – control group that in the most cases
is revealed by liquidation of compensatory waist posture, muscular hypotrophy and
reduction of strain level. Therapeutic effect achieved in patients with compressive
syndrome of lumbar osteochondrose was preserved in both basic groups. The majority
of objective symptoms were liquidated in the control group and difference between
I and III groups was not statistically significant. That points at equal therapeutic
effect, i.e. in the III group therapeutic effect was achieved after a year of treatment.
Based on mentioned data, we can say that by means of ridetherapy both
independently and in complex with traditional methods therapeutic effect is achieved
much earlier compared with traditional methods (therapeutic gymnastics) that took
whole year to achieve the same.
During the secondary prevention phase, positive dynamics in strength and
endurance of muscles supporting spine and muscles being in functional connection
with them was not seen. But obtained results and difference between them were
persistently preserved, i.e. most strong and long “muscular corset” developed in
patients treated only by ridetherapy (II group); after in patients treated by means of
ridetherapy and traditional methods (I group) and at last, in those treated by traditional
methods alone (III group).
In order to find out stability of physical rehabilitation effect, we studied longterm results – after 3 and 5 years of treatment using questionnaire. Frequency and
duration of disease exacerbations (Fi.g. 9)., clinical picture and remission type were
investigated (Fig. 10).
Fig. 9. Long-term results of treatment of patients with spinal osteochondrose
Frequency and duration of disease exacerbations
Fig. 10. Long-term results of treatment of patients with spinal osteochondrose
After 3 year of treatment
After 5 year of treatment
90
90
80
80
%
%
70
70
60
60
50
50
40
40
30
30
20
20
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Degree klinikal picture and character of remission
Mentioned parameters were collected before the rehabilitation from the case
histories. Stable data after 3 and 5 years from treatment were seen in I and II group
patients. Therapeutic effect was less stable in the III – control group. In particular,
after 3 years from treatment, osteochondrose exacerbations frequency, duration and
degree of clinical manifestations increased, but remission character did not change.
After 5 years from treatment, therapeutic effect was still stable in the basic groups, but
in III group frequency of exacerbations increased, remission character changed –
cases of complete remission decreased and incomplete B type cases increased.
Received data analysis indicates that stable therapeutic effect was achieved in
groups where ridetherapy was used.
I’d like to present a sportsman, rugby player who was injured at the game
(competition) and as a consequence of injury developed osteochondrose of lumbar
and thoracic parts of spine. He admitted our clinic in 6 months after exacerbation. He
had 8 months consecutive physical rehabilitation. Therapeutic gymnastics, classical
and hydro-massage, manual therapy and ridetherapy were used. At present he plays in
one of French city teams and is member
of Georgian national rugby team.
From time to time, when he arrives in Georgia he takes ridetherapy and maintains
sports fitness.
Based on data obtained after physical rehabilitation of spinal osteochondrose it
can be concluded that:
1.
Hippotherapy is an effective method for rehabilitation in case of osteochondrose
of spine, as treatment results are maintained for long period and the disease has
positive dynamics (during one year). Therapeutic effect implies release and
diminution of reflex and compressive symptoms, development-strengthening of
muscular system, widening of movement ability, increase in capability of
working;
2.
Hippotherapy hampers progression of spinal osteochondrose that is revealed by
long term results, in particular, diminution of severity and duration of
exacerbations, more mild clinical manifestations and mostly development of
complete remission;
3.
Therapeutic and preventive effect of hippotherapy is also conditioned by disease
localization, in particular, hippotherapy is more effective in case of lumbar and
thoracic osteochondrose compared with osteochondrose of neck.
Reference:
1. Rukhadze M., Tsverava D., Chkhikvishvili Ts., Ionatamishvili N., Loria M.
Effectiveness of ridetherapy after complex treatment of patients with loin
osteochondroseThe collection of scientific works, Tbilisi, 1993, p. 123-125 (in
Georgian)
2.
Rukhadze M., Therapeutisches Reiten im System der physischen Rehabilitation der Wirbel
saulenosteochondrose Therapeutisches Reiten. 3/99. Juli, 1999. XXYI. Jahrgang, p. 17-19.
3. Rukhadze M., General and special mechanisms of ridetherapy on osteochondrose
of spine Proc. Georgian. Acad. Sci., Biol. Ser., 1999, vol. 25, N1-3, 59-66.
4. Rukhadze M., Loria M. Integration of hipotherapy in the system of physical
rehabilitation of discases of the spine. `It`s the horse that makes the differen-ces“
.10th International Congress, Angers, France. 26-29 apr, 2000 p.84