Etiology and pathogenesis diseases of the digestive system are very diverse, violations of the activity of nervous system, local effects on the gastrointestinal tract of possible exogenous factors and circulatory disorders in the abdomen.

Violations of the activities of individual parts gastrointestinal tract at first usually functional and reversible. As the disease progresses, functional disorders are accompanied by morphological changes, which later become irreversible. Morphological changes, in turn, become a source of pathological impulses to the central nervous system and disrupt its corrective effect on the digestive organs and other organs and systems. As a result, an organic lesion of any part of the gastrointestinal tract is often combined with functional disorders of its other departments, as well as with a disorder in the activity of other systems.

The treatment of diseases of the digestive system is both etiological and pathogenetic, and in this complex therapy, exercise therapy drugs occupy an important place.

Therapeutic action Physical exercise is primarily due to the strengthening and normalizing effect on the nervous system. In case of impaired reactivity of the nervous system, physical exercises lead to the normalization of its activity, providing a balance between the process of excitation and inhibition in the cerebral cortex and improving the activity of the vegetative divisions, and as a result, the normalization of the functions of the digestive organs. Improving the function of the digestive organs with the help of physical exercises and massage is due to motor-visceral reflexes. It has been established that the receptors of muscles, tendons and joints serve not only for the implementation of movements, but also for the regulation of the most important autonomic functions, including the activity of the gastrointestinal tract.

Physical exercise activate tissue metabolism. Thanks to this, the nutrition of tissues and organs improves, the general tone of the body and the efficiency of patients increase. Influenced special exercises blood circulation in the abdominal organs improves and the amount of deposited blood decreases. This contributes to the subsidence of inflammatory processes in the organs of the gastrointestinal tract and the acceleration of regeneration processes in them (for example, scarring of an ulcer). Blood circulation improves simultaneously in the pelvic organs. Exercises for the muscles of the pelvic floor, preventing stagnation of blood in the rectum and hemorrhoidal veins, have a beneficial effect on the pathological processes in this area.

Providing a general tonic effect on the body and improving the state of the central nervous system and blood circulation, exercise therapy strengthens muscles abdominals, enhances intestinal peristalsis and the outflow of bile and gallbladder. The abdominal muscles play a significant role in the fixation of the abdominal organs and in their weakening. internal organs shifted downwards (the so-called splanchnoptosis). An effective means of preventing and treating splanchnoptosis are special exercises in combination with massage aimed at strengthening the abdominal muscles.

Local impact of exercise to the large intestine due to changes in intra-abdominal pressure during contraction and relaxation of the abdominal muscles and breathing. With contracted abdominal muscles, intra-abdominal pressure rises and exerts a pressor effect on the large intestine; when the abdominal muscles relax, the intra-abdominal pressure returns to its original value. Periodic change of increase and decrease in intra-abdominal pressure has a "massaging" effect on the colon and improves its functional state. Periodic changes in intra-abdominal pressure are also facilitated by deep breathing, in which the diaphragm contracts and thereby the volume of the abdominal cavity decreases; As a result, intra-abdominal pressure rises, when exhaling, the diaphragm relaxes, and therefore the volume of the abdominal cavity increases again and intra-abdominal pressure weakens. The combination of breathing exercises with exercises for the abdominal muscles provides a stronger effect on the colon.

Exercise therapy has a significant impact on the motor and secretory functions of the gastrointestinal tract. Large loads inhibit motility and secretion, moderate normalize them. Physical exercises in which pressure drops occur in the abdominal cavity (full deep breathing, torso bending, bending the legs in hip joints etc.), contribute to the improvement of the outflow of bile from the gallbladder, which is extremely important in diseases of the liver, biliary tract and gallbladder.

Physical exercise remains the most a simple means strengthening the drainage of the gallbladder.

A decrease in overall nutrition (hypotrophy) often complicates diseases of the digestive system. The main causes of malnutrition in these diseases are a violation of food digestion and absorption in the intestine due to morphological changes in the mucous membrane and malnutrition, when patients themselves limit it. The therapeutic effect of exercise therapy against the background of rational nutrition is due to a stimulating effect on metabolism. The unconditioned and conditioned reflex increase in metabolism is explained by the corrective influence of the nervous system on tissue trophism.

Exercise therapy technique

Contraindications To prescribing exercise therapy: the period of exacerbation of the disease - severe pain, severe dyspeptic disorders; general contraindications.

Motor mode is the use and rational distribution of various types of physical activity of the patient throughout the day, in a certain combination and sequence in relation to other factors of complex treatment.

Morning hygienic gymnastics pursues the goals of general development and strengthening of health, increasing efficiency. It helps hardening, contributes to a more complete transition from an inhibited state to an awake state, and eliminates stagnation in various departments.

In morning hygienic gymnastics, a small (8-10) number of exercises is used, covering the main muscle groups; exercise should be simple.

Therapeutic gymnastics is one of the main forms of exercise therapy.

At the core private technique therapeutic gymnastics, as well as general, are systematic, regularity, duration of classes, increased physical activity in the process of classes, individualization, the use of special and breathing exercises.

In addition to general developmental exercises, special exercises are used for the abdominal muscles and pelvic floor, breathing exercises(static and dynamic), exercises in voluntary muscle relaxation.

Attention! Exercises for the abdominal muscles in the subacute period of the disease are excluded.

Exercises in voluntary muscle relaxation reduce excitatory processes in the central nervous system, help accelerate the recovery processes of working muscles, lower the tone of not only the muscles involved in relaxation, but (reflexively) and smooth muscles of the internal organs of the stomach and intestines, relieve spasm of the intestines, the pylorus of the stomach and sphincters.

The therapeutic effect of therapeutic exercises will be much higher if special physical exercises are performed by muscle groups that receive innervation from the same segments. spinal cord, as the diseased organ (stomach C 3 -C 4 (from 3 to 4 cervical segments); liver, gallbladder C 3 -C 4, Th 6 -Th l0 (from 3 to 4 cervical and from 6 to 10 chest segments) , pancreas C 3 - C 4, Th 7 -Th 9 (from 3 to 4 cervical and from 7 to 9 chest segments) These are exercises involving the muscles of the neck, trapezius, muscles that raise the scapula; large and small rhomboid, diaphragm, intercostal muscles, anterior abdominal wall, ilio-lumbar, obturator, muscles of the foot and lower leg.

In diseases of the digestive system, the effectiveness of therapeutic exercises largely depends on the choice of starting positions, which allow differential regulation of intra-abdominal pressure.

The most commonly used starting position is lying with bent legs (on the left or right side, on the back); in emphasis, kneeling, standing on all fours, standing and sitting.

The initial lying position is recommended during the period of exacerbation and immediately after the exacerbation of the disease as the most sparing, contributing to the least functional shifts, providing the best conditions for performing breathing exercises (lying on your back with bent legs), voluntary muscle relaxation. These starting positions are convenient for performing exercises for the abdominal muscles and pelvic floor.

The anatomical and topographic relationships of the gallbladder, common bile duct and duodenum allow us to recommend the initial position lying on the left side, standing on all fours, in which the outflow of bile towards the bladder neck and ampulla is carried out under the influence of hydrostatic pressure. In addition, it accelerates the outflow of bile in these initial positions, an increase in intra-abdominal pressure during full breathing with an emphasis on the diaphragm and some participation of the abdominal mouse.

The starting position, kneeling (on all fours), is used if necessary to limit the impact on the abdominal muscles, cause mechanical movement of the stomach and intestinal loops; the initial standing and sitting positions are used for the greatest impact on the digestive organs.

Physiotherapy V aquatic environment held in pools with fresh or mineral water. Exercises are performed from the starting position lying with floating devices or at the handrail, sitting on a hanging chair, standing and moving.

The duration of the lesson is from 20 to 40 minutes. Water temperature 24-26 °C. The course of treatment is 12-15 procedures. Classes are conducted in an individual or small group method.

Terrencourt on fresh air trains and hardens the body, normalizes the psycho-emotional sphere. This is a natural physical exercise - walking.

It is possible to dose physical activity by changing the distance, elevation angle (route number), walking pace (passing a given distance in a certain period of time), the number of stops for rest and their duration, using breathing exercises during walking and rest, prescribing 1-2 or 3 walks per day, alternating days of training with days of rest.

Sport games from a physiological point of view, they are complex forms of acyclic muscle activity, which significantly complicates their dosage. This shortcoming is compensated by their high emotionality.

Game activity allows you to turn on and use the large reserve capabilities of the cardiovascular system.

Listed forms of exercise therapy, sports exercises and massage can be included in the motor mode of patients.

Approximate schemes of motor modes.

Mode with small physicalsome activity (sparing) adaptation recovery to enhanced mode loads is applied; stimulation of metabolic processes; fight against congestion in the abdominal cavity; normalization of regenerative processes; a positive effect on the psycho-emotional sphere of patients and a moderate increase in the adaptation of the cardiovascular system to increasing physical activity. With a sparing regime, periods of rest prevail over periods of load.

Contents of the regimen: include balneo- and physiotherapy procedures. Morning hygienic gymnastics by a small group method with a small load, duration 10-15 minutes, density of therapeutic exercises 40-50 %, LH by a small group method or individually, duration 20-25 minutes, occupation density 40-50%, dosed walks on flat terrain with a length of 0.5-1.5 km 1-2 times a day with an interval for rest of at least 1 -2 hours, at a pace characteristic of the patient's dynamic stereotype. Independent physical exercises 1-2 times a day for 6-8 special exercises. sedentary games(croquet, bowling alley) up to 30 min.

Indications for prescribing the regimen: diseases of the gastrointestinal tract in the stage of fading exacerbation, organic damage to the cardiovascular system with symptoms of circulatory failure, a tendency to vascular crises, poor general state(sharp weakness, fatigue).

Mode with average physical activity (gentle-training). Purpose: restoration of adaptation to training loads. Regulation of excitation and inhibition processes in the central nervous system, normalization of autonomic functions. Stimulation of metabolic processes, fight against congestion in the abdominal cavity, improvement of regenerative processes.

Contents of the regimen: include balneo- and physiotherapy procedures. Morning hygienic gymnastics by a group method with a small load (duration 12-15 minutes, motor density 50-60%), therapeutic exercises with medium load(duration 25-30 minutes, 3-4 lessons per day for 5-10 minutes). Dosed walks at a slow and medium pace with a length of up to 6 km and an elevation angle of up to 10 ° 1-2 times a day. It is allowed to play croquet, bowling alley, gorodki, table tennis, badminton according to simplified rules with a small load, on average up to 40-60 minutes. Sport exercises(water and winter sport) with a small load, metered rowing, horseback riding, ski trips.

Indications for prescribing the regimen: chronic diseases of the gastrointestinal tract in the phase of complete remission, 1-3 years after cholecystectomy and resection of the stomach, the initial effects of an organic lesion of the cardiovascular system with compensation for blood circulation and the absence of disorders heart rate. The mode is also shown to patients transferred from a sparing regimen.

Mode with great physical activity (training). Purpose: to maintain performance at the highest possible level.

Mode content: balneo- and physiotherapy procedures are provided in the daily routine. Morning hygienic gymnastics by a group method with an average load (15-20 min, motor density 60-70%), therapeutic exercises with a large load according to a special technique (30-45 min, motor density 60-70%). Self-training of patients with special exercises 3-4 times a day. Dosed walks at a slow pace along routes ranging from 10 to 20 km with an elevation angle of up to 20 °. Participation in competitions according to simplified rules is allowed. Sports exercises (water and winter sports) with an average load. Physical activity prevails over rest and relaxation.

Indications for prescribing the regimen: chronic diseases of the gastrointestinal tract in the phase of stable remission with stable compensation of functions. The regimen is also prescribed to patients transferred from a gentle training regimen in the second half of the course of treatment, subject to positive dynamics. The duration of the patient's stay in one or another mode of movement is not determined by a certain number of days. The attending physician transfers the patient from one mode to another based on favorable changes in his clinical condition with the adaptation of the cardiovascular system and the body as a whole to the previous mode of movement. It is not necessary to prescribe all forms of exercise therapy for the new regimen: the training effect can be achieved even with an increase in load in only one form of exercise therapy.

Diseases of the digestive system occupy a significant place in clinical medicine. Diseases of the digestive system often affect people of the most able-bodied age, causing a high rate of temporary disability and disability.

The location and general anatomy of the main parts of the digestive tract are shown in Fig. 181. The close anatomical and physiological relationship between the digestive organs makes it impossible to separately treat one or another organ in case of its disease.

In diseases of the digestive system, changes in motor, secretory and absorption functions are observed. Pathological processes of the gastrointestinal tract are closely interconnected and are caused by a violation of the nervous regulation.

As a result of a violation of the secretory function, gastritis, gastric and duodenal ulcers, etc. develop, and with a disorder of motor function - colitis, constipation, etc.

The main means of treating diseases of the digestive system are diet therapy, medicines, massage, movements (exercise therapy, moderate physical exercise etc.), physio- and hydroprocedures. Exercise therapy in this pathology has a general tonic effect, debugs neurohumoral regulation, stimulates blood and lymph circulation in the abdominal organs, strengthens the abdominal muscles, contributes to the normalization of evacuation and motor functions of the intestine, etc.

The result of the impact of physical exercises depends on their type, dosage, rhythm and pace of performance, on the stage of their application, the duration of the course, as well as on their combination with diet and other therapeutic agents.

Studies have shown that moderate physical education normalizes the secretory and evacuatory functions of the stomach, and intense physical training On the contrary, they are oppressive. The use of special exercises and segmental-reflex massage contributes to the normalization of impaired functions. So, exercises for the muscles of the abdominal wall and pelvic floor are good for chronic colitis, cholecystitis, dyskinesia, etc., and breathing exercises have a “massaging” effect on internal organs, improving blood and lymph circulation in the abdominal cavity. At the same time, exercises for the abdominal press, as studies have shown, dramatically increase intra-abdominal pressure, so they are contraindicated in patients with exacerbation of gastric and duodenal ulcers, with spastic colitis. Useful for such patients breathing exercises, relaxation exercises lying on your back with your legs bent at the knee and hip joints, or in the knee-elbow position.

Massage facilitates the release of bile (V.I. Dubrovsky, 1973, 1985) by increasing blood and lymph circulation in the liver and abdominal organs. Physical exercises contribute to the normalization of impaired functions in dyskinesia of the gastrointestinal tract and biliary tract.

Thus, exercise therapy and massage have a positive effect on the abdominal organs, stimulate the regulatory mechanisms of the digestive system.

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Introduction

1. Literature review

1.1 The effect of exercise on the activity of the digestive system

1.2 Features of the method of therapeutic physical culture in chronic gastritis

1.3 Features of the method of therapeutic physical culture in gastric ulcer

1.4 Therapeutic physical culture for biliary dyskinesia

2. Experimental part

2.1 Purpose, tasks and methodology of experimental work

3. Research results

4. Research results

List of used literature

Introduction

The state of health of schoolchildren is one of the most urgent problems of modern health care, the solution of which is unthinkable by the efforts of doctors alone without the involvement of teachers, students and their parents.

Scientific research in medicine can be divided into two areas: the study of diseases and the treatment of these diseases, that is, the study of diseases, and research in the field of disease prevention, that is, the study of health. Today, it is obvious that medical medicine is not able to solve all the problems associated with health, because despite the great achievements in scientific research and improving the technological medical base, successful outcomes of diseases are disproportionate to these achievements, and from the point of view of the economy, the increase in costs in medical medicine does not lead to an increase in positive results. In this regard, in recent decades, interest in preventive medicine has again increased. At the same time, the inconsistency of these studies on terminological, methodological and other aspects also manifested itself.

The child's body is special. Morphological and functional rearrangements occurring in it implement a certain genetic program aimed at the formation of a healthy individual. Environmental conditions can significantly change the implementation of the genetic program, both in the direction of providing optimal conditions for development, and in the direction of the formation of a pathological process.

Strengthening the health of the younger generation, optimizing the process of forming a healthy, harmoniously developed personality, mobilizing efforts to overcome the influence of negative socio-economic phenomena in society are the most important tasks of physical education for schoolchildren.

Their importance increases due to the deterioration of health, the growth of manifestations of social maladjustment and neuropsychiatric disorders in the structure of morbidity in children and adolescents.

Over the past 10 years, there has been a decrease in the number of healthy children by 4-5 times and a deterioration in the health of schoolchildren by 47%. Due to poor health, about 1 million school-age children are completely exempted from physical education.

In this regard, it is necessary to more fully use the health-improving possibilities of physical education in order to preserve and correct the health of schoolchildren in the educational process, to increase the level of their physical development And physical fitness, the formation of a healthy lifestyle in them through the use of new forms of organization of physical exercises, the use of modern physical culture and health technologies.

The organization of differentiated physical education of schoolchildren with different levels of health, the rational combination of the basic and variable components of the curriculum in physical culture, the inclusion of means with a health-improving and rehabilitation orientation in the content of physical education lessons, in our opinion, is given insufficient attention. Such works are isolated and fragmentary.

The contradictions between the need to improve physical education and the lack of scientifically based approaches in the field of individualization and differentiation of physical education of schoolchildren determined the relevance of the scientific problem, which is to determine how the educational process in physical education at school should be optimized when using differentiated physical education technologies.

digestion physical exercise therapeutic

The purpose of the thesis: to give a physiological justification for the need to use therapeutic physical culture in diseases of the digestive system in children.

According to this goal, the following tasks are set in the thesis work:

Study of the influence of physical exercises on the activity of the digestive organs;

Consider the features of the method of therapeutic physical culture in chronic gastritis;

Describe the features of the method of therapeutic physical culture in gastric ulcer;

Conduct experimental work on the use of therapeutic physical culture in diseases of the digestive system.

Object of study: the influence of physiotherapy exercises on the health of children with diseases of the digestive system.

Subject of study: the use of therapeutic physical culture in diseases of the digestive system.

Hypothesis: if a corrective and health-improving complex of physical exercises is used in a comprehensive school, this will help improve the health of children with diseases of the digestive system.

The Zatobolskaya secondary school No. 2 served as an experimental base for the study.

1. Literature review

1.1 The effect of exercise on the activity of the digestive system

Physical exercises for the purpose of treatment and prevention were used in ancient times, 2 thousand years before our era in China and India. in ancient Rome and Ancient Greece physical exercises and massage were indispensable in everyday life, military affairs, and treatment. Hippocrates (460-370 BC) described the use of physical exercises and massage for diseases of the heart, lungs, metabolic disorders, etc. Ibn-Sina (Avicenna, 980-1037) clarified in his writings the methodology for using physical exercises for sick and healthy, dividing the loads into small and large, strong and weak, fast and slow. During the Renaissance (XIV-XVI centuries), physical exercises were promoted as a means to achieve harmonious development.

In Russia, prominent clinicians such as M.Ya. Mudrov (1776-1831), N.I. Pirogov (1810-1881), S.P. Botkin (1831-1889), G.A. Zakharyin (1829-1897), A.A. Ostroumov (1844-1908), attached great importance to the use of physical exercises in the practice of treatment.

Proceedings of P.F. Lesgaft (1837-1909), V.V. Gorinevsky (1857-1937) contributed to understanding the unity of mental and physical education for more perfect development person.

Discoveries of great physiologists - I.M. Sechenov (1829-1922), Nobel Prize winner I.P. Pavlova (1849-1936), N.E. Vvedensky (1852-1922), who substantiated the importance of the central nervous system for the life of the body, influenced the development of a new approach to a comprehensive assessment of a sick person. The treatment of diseases gives way to the treatment of the sick. In this regard, the ideas of functional therapy and exercise therapy are beginning to spread more widely in the clinic, being such a method, it has found recognition and wide application.

For the first time in the period 1923-1924. Exercise therapy was introduced in sanatoriums and resorts. In 1926 I.M. Sarkizov-Serazini (1887-1964) headed the first department of exercise therapy at the Moscow Institute of Physical Culture, where the future first doctors and candidates of science (V.N. Moshkov, V.K. Dobrovolsky, D.A. Vinokurov, K.N. Pribylov and others).

Therapeutic physical education (LFK) is an independent scientific discipline. In medicine, it is a treatment method that uses physical culture for prevention, treatment, rehabilitation and supportive care. Exercise therapy forms a person's conscious attitude to physical exercises and, in this sense, has an educational value; develops strength, endurance, coordination of movements, instills hygiene skills, hardening the body with natural factors of nature. Exercise therapy is based on modern scientific data in the field of medicine, biology, physical culture.

The main means of exercise therapy are physical exercises used in accordance with the objectives of treatment, taking into account the etiology, pathogenesis, clinical features, the functional state of the body, the degree of general physical performance.

Physiotherapy:

A natural biological method, as it uses the function of movement inherent in the body;

The method of non-specific therapy, but at the same time, certain types of exercises can affect certain body functions;

The method of pathogenetic therapy, due to the possibility of physical exercises to influence the reactivity of the organism;

The method of active functional therapy, as it adapts the patient's body to increasing physical exertion;

The method of maintenance therapy at the stages of medical rehabilitation in the elderly;

The method of rehabilitation therapy in the complex treatment of patients.

Tasks of exercise therapy for diseases of the digestive system:

Contribute to the strengthening, healing of the body;

Influence the neuro-humoral regulation of digestion;

Stimulate blood circulation in the abdominal cavity and pelvis;

Strengthen the abdominal muscles;

Contribute to the normalization of secretory, motor and absorption functions;

Prevent congestion in the abdominal cavity;

To promote the development of the function of complete breathing;

The ability to use the advantages of diaphragmatic breathing in this pathology;

Have a positive impact on the psycho-emotional sphere.

A characteristic feature of exercise therapy is the process of training patients with physical exercises.

Distinguish between general and special training:

General training is aimed at improving, strengthening the patient's body with the help of general strengthening exercises;

Special training is carried out by exercises that purposefully affect the affected organ, the area of ​​injury.

Massage is a method of treatment, prevention, rehabilitation after diseases and recovery, which is a combination of methods of mechanical, dosed impact on various sections the surface of the human body, produced by the hands of a massage therapist or special devices. To achieve a positive result when applying massage, it is necessary to differentiate its methodology depending on the etiology, pathogenesis, clinical features, the functional state of the central and nervous system (CNS), the nature of the influence of various techniques on the body.

Exercise therapy and massage are widely used in combination with other methods for diseases and injuries, and can also be independent methods of treating many chronic diseases and the consequences of injuries: for paralysis, paresis, curvature of the spine, emphysema, consequences of bone fracture, etc.

The effect of physical exercise on the body. Physical exercises are natural and specially selected movements used in exercise therapy and physical education. Their difference from ordinary movements lies in the fact that they have a target orientation and are specially organized to improve health and restore impaired functions.

The effect of physical exercises is closely related to the physiological properties of muscles. Each striated muscle is made up of many fibers. The muscle fiber has the ability to respond to stimuli of the muscle itself or the corresponding motor nerve, i.e. excitability. Excitation is carried out along the muscle fiber - this property is referred to as conductivity. The muscle is able to change its length when excited, which is defined as contractility. The contraction of a single muscle fiber goes through two phases: contraction - with the expenditure of energy and relaxation - with the restoration of energy.

In muscle fibers during work, complex biochemical processes occur with the participation of oxygen (aerobic metabolism) or without it (anaerobic metabolism). Aerobic metabolism dominates during short-term intensive muscular work, and anaerobic metabolism provides moderate physical activity for a long time. Oxygen and substances that ensure the work of the muscles come with the blood, and the metabolism is regulated by the nervous system. Muscular activity is connected with all organs and systems according to the principles of motor-visceral reflexes; physical exercises cause an increase in their activity. Muscle contractions occur under the influence of impulses from the central nervous system.

The central nervous system regulates movements by receiving impulses from proprioreceptors that are located in muscles, tendons, ligaments, joint capsules, and periosteum. The response motor reaction of the muscle to irritation is called a reflex. The path of transmission of excitation from the proprioreceptor to the central nervous system and the response of the muscle constitute a reflex arc.

Physical exercise stimulates physiological processes in the body through the nervous and humoral mechanisms. Muscular activity increases the tone of the central nervous system, changes the function of internal organs and especially the circulatory and respiratory systems according to the mechanism of motor-visceral reflexes. Increased effect on the heart muscle vascular system and extracardiac circulatory factors; the regulatory influence of the cortical and subcortical centers on the vascular system is enhanced. Physical exercises provide more perfect pulmonary ventilation and constancy of carbon dioxide tension in arterial blood.

Physical exercises are carried out with the simultaneous participation of both the mental and physical spheres of a person. The basis in the method of physical therapy is the process of dosed training, which develops the adaptive abilities of the body.

Under the influence of physical exercises, the state of the main nervous processes normalizes - excitability increases with the intensification of inhibition processes, inhibitory reactions develop with pathologically pronounced increased excitability. Physical exercises form a new, dynamic stereotype, which contributes to the reduction or disappearance of pathological manifestations.

The products of the activity of the endocrine glands (hormones) entering the blood, the products of muscle activity cause changes in the humoral environment of the body. The humoral mechanism in the influence of physical exercises is secondary and is carried out under the control of the nervous system.

Physical exercise:

Stimulate metabolism, tissue metabolism, endocrine system;

Increasing immunobiological properties, enzymatic activity, contribute to the body's resistance to diseases;

Positively affect the psycho-emotional sphere;

Improving mood;

They have a tonic, trophic, normalizing effect on the body and form compensatory functions.

This action is based on the generally accepted principle of neurophysiology about the neuro-reflex mechanism.

Physical exercises cause non-specific physiological reactions in the patient's body, stimulation of the activity of all systems and the body as a whole.

The specificity of the influence of exercise therapy is that when using physical exercises, training is carried out, which helps to increase motor activity and physical performance.

The pathogenetic effect of exercise therapy is due to the fact that physical exercises are aimed at improving the functions of the affected systems and organs, as well as at the pathogenetic links of diseases.

Exercise therapy is a biological stimulant, enhancing the protective and adaptive reactions of the body. In their development, an important role belongs to the adaptive-trophic function of the sympathetic nervous system. The stimulating effect is manifested by an increase in proprioceptive afferentation, an increase in the tone of the central nervous system, and the activation of all physiological functions bioenergy, metabolism, increasing the functionality of the body.

The compensatory action is due to the active mobilization of all its mechanisms, the formation of stable compensation for the affected system, organ, compensatory replacement of the lost function.

Trophic action consists in activation of the trophic function of the nervous system, improvement of enzymatic oxidation processes, stimulation of immune systems, mobilization of plastic processes and tissue regeneration, normalization of disturbed metabolism.

As a result of all these processes, psycho-emotional unloading and switching, adaptation to household and labor physical loads, increased resistance to adverse factors of the external and internal environment, secondary prevention of chronic diseases and disability, and increased physical performance occur.

Diseases and injuries are accompanied by restriction of motor activity and force the patient to absolute or relative rest. This hypokinesia leads to a deterioration in the functions of all body systems, and not just locomotive apparatus. Exercise therapy reduces the harmful effects of hypokinesia and is the prevention and elimination of hypokinetic disorders.

The effect of exercise therapy on the patient depends on the strength and nature of the physical exercise and the body's response to this exercise. The response also depends on the severity of the disease, the age of the patient, individual characteristics of the response, physical fitness, psychological attitude. Therefore, the dosage of exercise should be prescribed taking into account these factors.

Muscular work affects various functions of the digestive system according to the principle of motor-visceral reflexes. The changes that occur as a result of physical activity are different. Intensive muscular work sharply slows down the motor, secretory and absorption functions, and moderate loads stimulate the activity of the digestive system.

In turn, physical activity through afferent, proprioceptive impulses from working muscles affects the central mechanisms of digestion regulation in the brain. Special physical exercises for the abdominal muscles have a direct effect on intra-abdominal pressure, exercises in diaphragmatic breathing change the position of the diaphragm, putting pressure on the liver and gallbladder. The combination of all these factors determines the positive role of exercise therapy in the complex treatment of patients with diseases of the digestive system.

1.2 Features of the method of therapeutic physical culture in chronic gastritis

Gastritis - inflammatory or inflammatory-dystrophic changes in the gastric mucosa.

Gastritis can be primary and develop as an independent disease or secondary, accompanying a number of infectious and non-infectious diseases and intoxications.

Gastritis is divided into acute and chronic. In acute gastritis, the development of inflammatory changes in the stomach occurs quickly - within a few hours and even minutes.

However, the most common chronic gastritis, a characteristic feature of which is the gradual development of the inflammatory process, leading to changes in the mucous membrane, impaired motor and secret functions.

With this form of gastritis, other digestive organs often suffer: the liver, gallbladder, pancreas, as well as the nervous and endocrine systems.

Chronic gastritis is a polyetiological disease, the main causes of which are:

Prolonged violation of the diet;

Eating foods that irritate the gastric mucosa;

Predilection for too hot or spicy food;

Poor chewing of food;

Dry food;

Frequent use of alcoholic beverages;

Malnutrition (especially lack of protein, vitamins and iron).

Other diseases of the digestive system (appendicitis, colitis, cholecystitis, etc.) can also contribute to the development of chronic gastritis. Violations in the activity of the endocrine glands, the autonomic nervous system can affect the secretory and other functions of the stomach.

Chronic gastritis is a gradually progressive disease: periods of exacerbation are replaced by periods of remission.

In case of diseases of the digestive system, therapeutic exercises play an important role in the complex of therapeutic agents.

Physical exercise affects the digestive system by the type of motor-visceral reflexes. Short muscle loads of low and medium intensity increase the excitability of the cerebral cortex, including the food center, which, in turn, activates autonomic functions and improves digestion. The abdominal muscles and diaphragm, as if massaging the abdominal organs, activate the functions of the digestive tract.

Intense physical activity has a depressing effect on digestion. At the same time, the secretion of gastric juice decreases, acidity decreases.

The inhibitory effect of physical exercise is more pronounced immediately after a meal, so the training load during this period can cause not only functional, but also organic disorders in the digestive system.

1-2 hours after eating, physical activity even above average intensity gives positive effect. By this time, the activity of the vagus nerve, which provides the motor and secretory functions of the gastrointestinal tract, decreases.

Therefore, knowing the nature of the violation of the secretory or motor function and taking into account the phase of digestion, it is possible to achieve the normal functioning of the digestive organs through the differentiated assignment of physical activity of varying intensity.

Under the influence of physical exercises, the trophic processes of the digestive organs are improved - the blood supply to the abdominal organs is activated and the amount of deposited blood decreases, which contributes to the attenuation of inflammatory processes and the acceleration of regeneration processes.

Physical exercises have a tonic and normalizing effect on the body, contributing to the normalization of motor-visceral reflexes.

Thus, the mechanisms of the therapeutic effect of physical exercises on the digestive organs are reduced to a change in the functional state of the cerebral cortex and the tone of the autonomic nervous system.

With the help of therapeutic physical culture, the following tasks are solved for diseases of the digestive system, in particular for gastritis:

Providing a positive effect on the neuropsychic and emotional spheres (since the processes of digestion in the body are regulated by the central nervous system);

Development and improvement of external and especially diaphragmatic breathing;

Impact on the secretory and motor functions of the stomach, as well as on the neurohumoral regulation of digestive processes;

Improvement of the trophism of the gastric mucosa;

Improving blood circulation in the abdominal cavity and creating favorable conditions for regenerative processes.

Therapeutic physical culture is used in the phase of attenuation of exacerbation and the phase of remission. In the acute phase and in case of complications, physical therapy should be discontinued.

The method of therapeutic physical culture provides for a combination of general developmental and special exercises. General developmental exercises have a tonic effect on the central nervous system, improves the function of the digestive system. As special exercises, exercises for the muscles surrounding the abdominal cavity are used.

Exercises for the abdominal muscles are prescribed taking into account the phase of the disease. They are indicated, if necessary, to strengthen peristalsis, the secretory function of the stomach and the outflow of bile. In the acute and subacute phases they are excluded.

Diaphragmatic breathing exercises have a massaging effect on the stomach.

The choice of initial exercises depends on the nature of the exercises performed and the phase of the disease. For exercises in muscle relaxation, as well as after an exacerbation of the disease, the most favorable initial position is lying down. In the sitting position, exercises are performed on bed or semi-bed rest. In order to mechanically move the stomach, as well as to limit the impact on the abdominal muscles, the initial positions are used in an emphasis on kneeling and standing.

Depending on the phase of the disease, the pace and rhythm of performing physical exercises are determined. In the subacute phase, a slow pace and monotonous rhythm is used, and in complete remission, any rhythm and change of rhythms is recommended.

The main purpose of physical exercises is general improvement, normalization of the secretory-motor function of the digestive tract.

Treatment and rehabilitation for chronic gastritis are complex and include the following activities.

Drug treatment aimed at eliminating the inflammatory process and affecting the mechanisms of development of the pathological process;

Exercise therapy classes (therapeutic gymnastics, health path, outdoor games, elements of sports games);

Diet ( medical nutrition and compliance with the diet);

Elimination of professional and bad habits;

Physiotherapy;

Local effect on the gastric mucosa (rosehip or sea buckthorn oil, mineral water).

With gastritis with secretory insufficiency, a moderate effect of physical activity on the entire body is shown. In accordance with the period of treatment and the motor regimen, general developmental exercises are used, at a slow pace, with a limited amplitude and a small number of repetitions; special exercises for the abdominal muscles with a gradual increase in load, static and dynamic breathing exercises, as well as slow walking for up to 30 minutes.

In the I period, corresponding to the acute and subacute phases of the disease, therapeutic exercises are carried out 2 hours before meals and 20-40 minutes before taking mineral water - to improve blood circulation in the stomach. Starting positions - lying on your back, on your side, reclining; then sitting and lying down. The duration of the lesson is 20-25 minutes.

Not earlier than 1.5-2 hours after eating, walking is used to improve the evacuation function of the stomach. The pace of walking is slow, with a gradual increase in the duration of walking - up to 30 minutes. During the period of remission, it is allowed to perform exercises to increase intra-abdominal pressure in the initial position lying on the stomach. In combination with therapeutic exercises, it is recommended to massage the anterior abdominal wall.

With gastritis with increased secretion, therapeutic physical culture is carried out before meals with an increasing load. The patient must be sufficiently physically prepared to perform exercises for medium and large muscles, with a large number of repetitions, swing movements, exercises with projectiles that serve to reduce gastric secretion.

In the II period, in addition to general strengthening exercises, special exercises are included in the classes with an emphasis on diaphragmatic breathing and relaxation. A good effect in relaxing the muscles of the stomach gives a segmental massage.

In the III period, the means of therapeutic physical culture are expanding: walking, moving and sport games(volleyball, badminton, tennis), skiing, skating, swimming, rowing, hiking, dosed running, health path. Therapeutic exercises are carried out between the intake of mineral water and lunch, as mineral water inhibits the secretion of the stomach.

The influence of the nature of physical activity on various functions of the stomach is shown in table 1.

Table 1

The influence of the nature of physical activity on various functions of the stomach

The nature of physical activity	Motor function of the stomach	secretory function of the stomach	Suction
intensive	Weakens	Weakens	getting worse
low-intensity	intensifies	intensifies	Improving
Short (up to 1 hour)	intensifies	intensifies	Improving
Long (1.5-2 hours)	Weakens	Weakens	getting worse
Right before a meal	Weakens	Weakens	getting worse
1-2 hours after eating; 1-2 hours before meals	intensifies	intensifies	Improving

The dosage of physical activity is carried out in accordance with the physical fitness of patients, the functional state of the cardiorespiratory system, and also depending on concomitant diseases that limit physical performance.

With hypocidic gastritis, atony of the stomach and intestines, moderate physical activity, which does not cause fatigue, increases metabolism, improves blood circulation and stimulates the activity of all organs of excretion of digestive juices.

For patients suffering from low and zero acidity of gastric juice, in order to normalize the acidity of the stomach and improve the functioning of the digestive organs, a set of eighteen simple physical exercises is proposed below, which should be performed, gradually increasing the pace towards the middle of the complex, and then gradually towards the end of the lesson. reduce it.

To perform exercises from 1 to 5, the starting position is standing.

Exercise 1. Putting the right leg back, raise your hands up - inhale, return to the starting position - exhale. The same for the left leg. The pace is slow. Run 3-4 times.

Exercise 2. Torso twists. Hands to the sides - inhale, turn 90 ° to the right - exhale, return to the original position - inhale.

Turn 90 ° to the left - exhale, return to the starting position - inhale. The pace is slow. Run 3-4 times in each direction.

Exercise 3. Tilts to the side. Lean to the right - exhale, straighten up - inhale; lean to the left - exhale, straighten - inhale. Breathing is even. The pace is slow. Run 3-4 times.

Exercise 4. Exercise "woodcutter". Leaning forward - exhale, returning to its original position - inhale. The exercise imitates chopping wood. The pace is fast. Run 3-4 times.

Exercise 5. Full breath. The pace is slow. Run 3-4 times.

Exercise 6. Starting position - sitting. Legs are straight, hands are in support behind. To bend - inhale, return to the starting position - exhale. The pace is slow. Run 4-6 times.

To perform exercises from 7 to 9, the starting position is lying on your back.

Exercise 7. Alternately lifting the right, then the left straight leg. Raising the leg - exhale, lowering - inhale. The pace is slow. Run 4-6 times.

Exercise 8. Exercise "bike". Breathing is even. The pace is average. Perform within 15-25 seconds.

Exercise 9. Full deep breathing - 3-4 times. The pace is slow.

Exercise 10. Starting position - lying on your stomach. Bending the arms in emphasis. Pushing up from the floor, exhale, returning to the starting position - inhale. The pace is average. Run 5-10 times.

To perform exercises 11 and 12, the starting position is standing.

Exercise 11. Squats. Squatting, exhale, returning to the starting position - inhale. The pace is average. Run 5-15 times.

Exercise 12. Raise the straight right leg - exhale, take it back - inhale. The pace is average. Run 4-6 times. The same for the left leg.

To perform exercises 13 and 14, the starting position is sitting.

Exercise 13. Find a footrest. Lean back - inhale, return to the starting position - exhale. The pace is slow. Run 3-5 times.

Exercise 14. Starting position - sitting. Full slow breathing under the control of the hands. Put your right hand on your chest, left hand on your stomach.

At the expense of one or two, we begin to take a slow diaphragmatic breath, the diaphragm goes down, while the stomach protrudes. This movement is fixed by the left hand. On the count of three or four, we continue to take a full breath, but already with the chest. It fixes the right hand. At the same time, the chest rises, the shoulders turn around, and the head leans back a little. At the expense of five or six, we begin to make a slow diaphragmatic exhalation, the diaphragm goes up, and the stomach is drawn in. This movement is fixed by the left hand. On the count of seven or eight, we continue to exhale completely, but with the chest. It fixes the right hand. At the same time, the chest drops, the shoulders come together, the head falls on the chest. On a count of nine to ten, try to hold your breath while exhaling completely. (In the future, the time of holding the breath at full exhalation should be gradually increased, but not by force.) Repeat the exercise 3-5 times.

Exercise 15. Starting position - on all fours. Synchronous lifting of the arm and leg. We raise the right arm and right leg - inhale, lower - exhale; raise the left arm and left leg - inhale, lower - exhale. The pace is average. Run 3-8 times.

To perform exercises from 16 to 18, the starting position is standing.

Exercise 16 Breathing is even. Run 15-60 times, then switch to walking.

Exercise 17. Walking in place for 1.5 minutes.

Exercise 18. Full breath - 1.5-2 minutes. The pace is slow.

In addition to therapeutic exercises and walks, patients with hypocidic gastritis are advised to go in for swimming (especially with prolapse of the stomach and intestines), rowing, volleyball, tennis, weekend tourism, skiing and skating. It is very good for such patients, along with exercises for all muscle groups, to perform exercises with a load on the abdominal muscles.

For constipation, which very often accompanies atony, one should perform additional exercises associated with body concussion (running, jumping rope, horseback riding, sports games, skiing and rowing).

Thus, thanks to the complex use of health-improving gymnastics, anti-inflammatory and reparative therapy, hygiene procedures and diet therapy in combination with medical therapy, it becomes possible to solve the global task of normalizing the functioning of the gastrointestinal tract at the stage of preparing the body for colon cleansing.

1.3 Features of the method of therapeutic physical culture in gastric ulcer

Peptic ulcer is a chronic, cyclically occurring disease with a varied clinical picture and ulceration of the mucous membrane of the stomach or duodenum during periods of exacerbation.

The leading symptom in the clinical picture of peptic ulcer is pain. Its distinctive features should be considered periodicity (alternation of periods of exacerbations and remissions), rhythm (relationship of pain with food intake), seasonality (exacerbation in spring and autumn, and in some patients - in winter and summer), the increasing nature of pain as the disease develops, changes and disappearance of pain after eating, antacids; application of heat, anticholinergics, after vomiting.

According to the time of onset of pain after eating, they are divided into early, occurring shortly after eating, late (after 1.5 - 2 hours) and night. Early pain is characteristic of ulcers located in the upper part of the stomach. For ulcers of the antrum of the stomach and ulcers of the duodenum, late and nocturnal pains are characteristic, which can also be "hungry", as they decrease or stop after eating.

Pain in peptic ulcer reaches its maximum strength at the height of digestion and only "hungry" pains disappear after eating. In the presence of perigastritis or periduodenitis, the pain is aggravated by physical exertion. The decrease or cessation of pain after an accidental vomiting leads to the fact that patients, when pain occurs, cause vomiting artificially. No less typical for peptic ulcer is a lightning-fast cessation of pain after taking alkalis.

Vomiting in peptic ulcer disease occurs without previous nausea, at the height of pain in the midst of digestion, with different localization of the ulcerative process, its frequency varies. The secretion of active gastric juice on an empty stomach is often accompanied by vomiting. Frequent morning vomiting of the remnants of food eaten the day before indicates a violation of the evacuation function of the stomach.

Of the dyspeptic phenomena in peptic ulcer, heartburn occurs more often (in 60-80% of all patients with peptic ulcer). From a diagnostic point of view, it is important that it is noted not only during periods of exacerbations, but may precede them for a number of years and has the same typical features as pain (periodicity, seasonality). Heartburn is associated with impaired motor function of the esophagus and stomach, and not with secretory function, as previously thought. When inflating the esophagus, stomach, duodenum with a rubber balloon, you can cause a burning sensation of varying degrees, up to a sensation of "burning convulsions".

Appetite in peptic ulcer disease is not only preserved, but sometimes even sharply increased. Since pain is usually associated with eating, sometimes patients have a fear of eating. Some people with peptic ulcers periodically experience increased salivation, preceded by nausea. Often there is a feeling of pressure of gravity in the epigastric region. These phenomena are characterized by the same patterns as pain.

Constipation is often noted during an exacerbation. They are due to the nature of the nutrition of patients, bed rest and mainly neuromuscular dystonia of the large intestine of vagal origin. The general nutrition of patients with peptic ulcer is not disturbed. Weight loss can be observed during an exacerbation of the disease, when the patient restricts food intake due to fear of pain. With superficial palpation of the abdomen, tension of the right rectus muscle can be detected, which decreases as the pathological process subsides.

According to the clinical course, acute, chronic and atypical ulcers are distinguished. Not every acute ulcer is a sign of a peptic ulcer.

A typical chronic form of peptic ulcer is characterized by a gradual onset, an increase in symptoms and a periodic (cyclic) course.

The first stage - the prelude of an ulcer, is characterized by pronounced disturbances in the activity of the autonomic nervous system and functional disorders of the stomach and duodenum, the second - by the appearance of organic changes, initially in the form of a structural reorganization of the mucous membrane with the development of gastroduodenitis, the third - by the formation of an ulcer in the stomach or duodenum, the fourth - the development of complications.

The duration of periods of remission in peptic ulcer disease ranges from several months to many years. The recurrence of the disease can be caused by mental and physical stress, infection, vaccination, trauma, medication (salicylates, corticosteroids, etc.), insolation.

Causes of occurrence: damage to the nervous system (acute psychotrauma, physical and mental overwork, nervous diseases), hormonal factor (impaired production of digestive hormones - gastrin, secretin, etc., impaired histamine and serotonin metabolism, under the influence of which the activity of the acid-peptic factor increases) .

Impulses from the receptors of the internal organs enter the central nervous system, signaling the intensity of functioning and the state of the organs. When the disease occurs, a violation of reflex regulation occurs, pathological dominants and vicious (pathological) reflexes arise, perverting the course of normal processes in the human body.

It is already known that the implementation of dosed physical exercises, accompanied by positive changes in the functional state of the centers of the hypothalamic region and an increase in the level of basic life processes, causes positive emotions(the so-called psychogenic and conditioned reflex influence). This is especially applicable in case of peptic ulcer, when the neuropsychic state of patients leaves much to be desired (normalization of the dystonic phenomena expressed in patients from the nervous system). It should be noted the effect of physical activity on the nervous regulation of the digestive apparatus.

Depending on the clinical orientation of the disease and the functionality of the patient, various forms and means are used.

Contraindications to classes include:

Fresh ulcer in the acute period;

An ulcer complicated by bleeding;

preperforative state;

An ulcer complicated by stenosis in the stage of decompensation;

Fresh massive paraprocesses during penetration;

Severe dyspeptic disorders;

Severe pain;

General contraindications;

Regulation of the processes of excitation and inhibition in the central nervous system;

Normalization of the neuropsychological tone of the patient;

Improving the function of respiration, blood circulation and digestion, redox processes;

Normalization muscle tone(which is a powerful regulator of internal organs), increased muscle strength, proprioceptive sensitivity;

Development of the necessary motor qualities, skills and abilities (breathing, muscle relaxation, elements of autogenic training, coordination of movements, etc.).

Morning hygienic gymnastics pursues the goals of general development and strengthening of health, increasing efficiency, and helps hardening, contributes to a more complete transition from an inhibited state to an awake one. In morning hygienic gymnastics, a small (8-10) number of exercises is used, covering the main muscle groups; exercise should be simple.

The therapeutic effect of LH will be much higher if special physical exercises are performed by muscle groups that receive innervation from the same segments of the spinal cord as the affected organ. These are exercises involving the muscles of the neck, trapezius, muscles that lift the scapula, large and small rhomboid, diaphragm, intercostal muscles, anterior abdominal wall, iliopsoas, obturator, muscles of the foot and lower leg.

In diseases of the digestive system, the effectiveness of LH largely depends on the choice of starting positions, which allow differential regulation of intra-abdominal pressure.

The most commonly used position is lying with bent legs (on the left or right side, on the back); in emphasis, kneeling, standing on all fours, standing and sitting.

The prone position is recommended during the period of exacerbation and immediately after the exacerbation of the disease as the most gentle, contributing to the least functional shifts, providing the best conditions for performing breathing exercises (lying on your back with bent legs), voluntary muscle relaxation. These starting positions are convenient for performing exercises for the abdominal muscles and pelvic floor.

The anatomical and topographic relationships of the gallbladder, common bile duct and duodenum allow us to recommend the position lying on the left side, standing on all fours, in which the outflow of bile towards the neck of the bladder and the ampulla is carried out under the influence of hydrostatic pressure. In addition, the outflow of bile in these initial positions is accelerated by an increase in intra-abdominal pressure during full breathing with an emphasis on the diaphragm and some participation of the abdominal muscles.

The kneeling position (on all fours) is used if necessary to limit the impact on the abdominal muscles, cause mechanical movement of the stomach and intestinal loops; standing and sitting positions are used for the greatest impact on the digestive organs.

LH in the aquatic environment is carried out in pools with fresh or mineral water. Exercises are performed from a prone position with floating devices or at the handrail, sitting on a hanging chair, standing and moving. The duration of the lesson is from 20 to 40 minutes. Water temperature 24-26°C. The course of treatment is 12-15 procedures. Classes are conducted both individually and in small groups.

LH is used after the acute period of the disease. Exercises should be done carefully if they aggravate the pain. Complaints often do not reflect the objective state and the ulcer can progress with subjective well-being (disappearance of pain, etc.). In this regard, in the treatment of patients, the abdominal area should be spared and very carefully, gradually increase the load on the abdominal muscles. It is possible to gradually expand the motor mode of the patient by increasing total load when doing most exercises, including diaphragmatic breathing exercises and exercises for the abdominal muscles.

LH classes are first carried out in relation to bed rest. In the first lessons, it is necessary to teach the patient abdominal breathing with a small amplitude of abdominal wall oscillations. These exercises, causing slight changes in intra-abdominal pressure, help to improve blood circulation and gentle massage of the abdominal organs, reduce spastic phenomena and normalize peristalsis. Movements in the large joints of the limbs are performed first with a shortened lever and a small amplitude. You can use exercises in static tension of the muscles of the belt of the upper limbs, abdominals and lower extremities. It is necessary to turn in bed and move into a sitting position calmly, without significant stress. The duration of the LH classes is 8-12 minutes.

With a noticeable subsidence of pain and other exacerbation phenomena, the disappearance or decrease in the rigidity of the abdominal wall, a decrease in soreness and an improvement in the general condition, a ward regimen is prescribed (approximately 2 weeks after admission to the hospital). Exercises from a prone, sitting, standing, kneeling position are performed with gradually increasing effort for all muscle groups (with the exception of the abdominal muscles), with incomplete amplitude, at a slow and medium pace. Short-term moderate tension of the abdominal muscles is allowed in the supine position. Gradually, diaphragmatic breathing deepens. The duration of the LH classes is 15-18 minutes.

After the disappearance of pain and other signs of exacerbation, in the absence of complaints and general satisfactory condition, a free regimen is prescribed. In LH classes, exercises are used for all muscle groups (sparing the abdominal area and excluding sudden movements) with increasing effort from various starting positions. They include exercises with dumbbells (0.5-2 kg), stuffed balls (up to 2 kg), exercises on the gymnastic wall and bench. Diaphragmatic breathing is carried out with maximum depth. Walking is brought up to 2-3 km per day, walking up the stairs - up to 4-6 floors, outdoor walks are desirable. The duration of the LH class is 20-25 minutes.

In the conditions of sanatoriums and resorts, where patients undergo treatment during the remission period, the volume and intensity of PH exercises increase: general strengthening, breathing exercises, exercises for coordination of movements are widely used, mobile and some sports games (badminton, table tennis), relay races are allowed. A health path, walks, and in winter skiing should be recommended (the route should exclude ascents and descents with a steepness exceeding 15-20 °; an alternating style of walking is shown). In the LH procedure, strength, speed-strength exercises, static efforts and stresses, jumps and jumps, and exercises at a fast pace are excluded.

Approximate schemes of motor modes:

The mode with low physical activity (sparing) is used to restore adaptation to the loads of the extended mode; stimulation of metabolic processes; fight against congestion in the abdominal cavity; normalization of regenerative processes; a positive effect on the psycho-emotional sphere of patients and a moderate increase in the adaptation of the cardiovascular system to increasing physical exertion. With a sparing regime, periods of rest prevail over periods of load.

Contents of the regimen: include balneo- and physiotherapy procedures. Morning hygienic gymnastics is carried out by a small-group method with a small load, lasting 10-15 minutes, the density of the LH class is 40-50%. LH is carried out by a small group method or individually, the duration is 20-25 minutes, the density of the lesson is 50%. Dosed walks on flat terrain with a length of 0.5-1.5 km 1-2 times a day with an interval for rest of at least 1-2 hours, at a pace characteristic of the dynamic stereotype of the patient. Independent physical exercises 1-2 times a day for 6-8 special exercises. Sedentary games (croquet, bowling alley) up to 30 minutes. Indications for prescribing the regimen: diseases of the gastrointestinal tract in the stage of fading exacerbation, poor general condition (severe weakness, fatigue).

Mode with average physical activity (sparingly training).

Purpose: restoration of adaptation to training loads. Regulation of excitation and inhibition processes in the central nervous system, normalization of autonomic functions. Stimulation of metabolic processes, fight against congestion in the abdominal cavity, improvement of regenerative processes.

Contents of the regimen: include balneo- and physiotherapy procedures. Morning hygienic gymnastics by group method with low load (duration 12-15 minutes, motor density 50-60%). LH with an average load (duration 25-30 minutes, 3-4 sessions a day for 5-10 minutes). Dosed walks at a slow and medium pace with a length of 6 km and an elevation angle of up to 10 ° 1-2 times a day. It is allowed to play croquet, bowling alley, gorodki, table tennis, badminton according to simplified rules with a small load, on average up to 40-60 minutes. Sports exercises (water and winter sports) with a small load, dosed rowing, horseback riding, skiing.

The content of the regimen: in the daily regimen, balneo- and physiotherapy procedures are provided. Morning hygienic gymnastics by group method with an average load (15-20 minutes, motor density 60-70%). LH with a heavy load according to a special technique (30-45 minutes, motor density 60-70%). Self-study of patients with special exercises 3-4 times a day. Dosed walks at a slow pace along routes from 10 to 20 km long with an elevation angle of up to 20 °. Participation in competitions according to simplified rules is allowed. Sports exercises (water and winter sports) with an average load. Physical activity prevails over peace and rest.

Indications for prescribing the regimen: chronic diseases of the gastrointestinal tract in the phase of stable remission with stable compensation of functions. The regimen is also prescribed to patients transferred from a sparing training regimen in the second half of the course of treatment, subject to positive dynamics. The duration of the patient's stay in one or another mode of movement is not determined by a certain number of days. The attending physician transfers the patient from one mode to another based on favorable changes in his clinical condition with the adaptation of the cardiovascular system and the body as a whole to the previous mode of movement. It is not necessary to prescribe all forms of exercise therapy for the new regimen: the training effect can be achieved even with an increase in load in only one form of exercise therapy.

Target setting: restoration of the patient's adaptation to the loads of the extended mode. Increasing stimulation of metabolic processes, impact on the regulation of excitation and inhibition processes in the cerebral cortex, impact on the normalization of autonomic functions. Fight congestion in the abdominal cavity. Promoting regenerative processes in the gastrointestinal tract.

Gradually increases (up to about 40-50%) and the intensity of resistance exercises for muscles shoulder girdle and intercostal muscles for the purpose of a reflex effect on the digestive organs. You can use dumbbells weighing up to 2-4 kg, stuffed balls weighing no more than 2-3 kg, exercises on sports equipment. To combat congestion, a good effect is given with diaphragmatic breathing from various starting positions, which is brought to a great depth, alternating with chest and full breaths; also helps more frequent change of starting positions, exercises, games and loads with their complication. Gradually, more difficult exercises for attention are included in the classes. At the same time, the density of classes remains not above average.

Walking is brought up to 4-5 km per day. With general good health and no pain, ball games (volleyball, etc.) are allowed, taking into account individual reactions lasting no more than 25-35 minutes. The inclusion of various types of games in the course helps to maintain interest and increases the production of positive emotions during general physical activity.

In the course of the entire course, the patient should be pointed out to the positive changes achieved in his condition and physical development, instilled that the disturbances in the stomach are minor and easily remedied (psychological impact).

Exercise therapy is effective only under the condition of a long, systematic training with a gradual increase in the load both in each of them and throughout the course. Below is a table (table 2) of an approximate construction of a lesson for the stage of remission of the ulcer process.

A strict sequence in increasing the load and its individualization are the main conditions for all classes. This should take into account the condition, the reaction of students, the characteristics of the clinical course, concomitant diseases and physical fitness of students.

Another thing is also important: while doing physical exercises, the patient himself actively participates in the healing process, and this has a beneficial effect on his psycho-emotional sphere.

table 2

Scheme of the LH procedure for patients with duodenal ulcer in remission

	Dosage, min	Section tasks, procedures
Walking simple and complicated, rhythmic, at a calm pace		Gradual involvement in the load, development of coordination
Exercises for arms and legs combined with body movements, breathing exercises in a sitting position		Periodic increase in intra-abdominal pressure, increased blood circulation in the abdominal cavity
Standing exercises in throwing and catching the ball, throwing a medicine ball (up to 2 kg), relay races, alternating with breathing exercises		General physiological load, creation of positive emotions, development of full breathing function
Exercises on the gymnastic wall like mixed hangs		General tonic effect on the central nervous system, development of static-dynamic stability
Elementary lying exercises for limbs in combination with deep breathing		Reducing the load, the development of full breathing

Classes also have an educational value: patients get used to systematically perform physical exercises, this becomes their daily habit. Exercise therapy classes turn into general physical education classes, become a person's need even after recovery.

1.4 Therapeutic physical culture for biliary dyskinesia

Biliary dyskinesia - functional disorders of the motor function of the gallbladder and extrahepatic bile ducts. According to statistics, women are more likely to suffer from biliary dyskinesia. Increased contractile activity of the biliary tract (hyperkinetic dyskinesia) is more common at a young age, weakening (hypokinetic dyskinesia) - in people with an unstable psyche over 40 years old.

In their majority, biliary dyskinesias are secondary and arise as a result of violations of the neurohumoral regulation of bile secretion, pathological impulses from other digestive organs, kidneys and genitals. A long-term diet with the exclusion of natural choleretic agents, toxic damage to smooth muscles and nerve ganglia of the biliary system, and acute hepatitis are important. In the occurrence of dyskinesias, great importance is attached to immune mechanisms. With severe asthenia, a sedentary lifestyle, poor nutrition with very long intervals between meals, a hypokinetic form of dyskinesia (reduced contractile activity) is relatively often detected. In addition to psychogenic disorders, food allergies are also mentioned as etiological factors. And also, dyskinesia can join cholecystitis and cholelithiasis. The hyperkinetic form (increased contractile activity) occurs reflexively with peptic ulcer, colitis, appendicitis, and some other diseases.

The first signs of the disease appear in preschool and school age, the peak incidence occurs at 7-9 years. Patients with JVP are more common in families where there are conflict situations that lead to the development of neurosis in children. The significance of hereditary factors in the occurrence of JVP has not been directly proven, but it must be borne in mind that the child's body may have a hereditary predisposition to the weakness of adaptive mechanisms, manifested by frequent colds, allergic reactions, and neurological disorders.

Physiotherapy exercises are used for all chronic diseases of the biliary tract in children, which are accompanied by disorders of the general metabolism of the digestive function, congestion in the liver and impaired motor functions of the gallbladder.

The tasks of therapeutic physical culture in diseases of the liver and biliary tract:

Improving metabolism, healing and strengthening the body;

Reducing congestion in the liver and gallbladder;

Removal of spasmodic phenomena in the gallbladder and ducts;

Increased mobility of the diaphragm - the main regulator of intra-abdominal pressure;

Improvement of blood circulation in the liver and other organs of the abdominal cavity;

Facilitate the outflow of bile in the gallbladder;

Strengthening the abdominal press in order to keep the abdominal organs in a normal position, as well as the settlement of the functions of the stomach and intestines;

Compensation for the deficiency of muscle activity (the main stimulator of the function of internal organs) caused by the disease.

Classes of therapeutic physical culture are indicated during the period of hospitalization in the absence of frequent attacks and exacerbation. However, it is not contraindicated:

The presence of subfebrile body temperature;

The presence of pain on palpation in the gallbladder, a slight increase in the liver, and slight pain in the liver;

Slight jaundice, sometimes occurring in patients with angio-cholecystitis as a result of a delay in the outflow of bile from the gallbladder, because. exercises for the abdominal muscles and breathing exercises help to improve bile secretion and the rapid elimination of jaundice;

Exercise therapy is completely contraindicated in the acute period of the disease with high body temperature, ESR and severe pain;

After discharge from the hospital, exercise therapy is not only indicated, but also necessary, since in most cases patients leave the hospital with residual symptoms of the disease. It is during this period that systematic exercises of exercise therapy can significantly improve the health of the patient.

Gymnastic exercises effectively affect the body, normalizing or improving neuro-trophic processes and metabolism. A well-chosen set of exercises allows you to diversify various groups muscles, respiratory and circulatory systems, affect the functional functions of internal organs. Under the influence of regularly conducted physical exercises, the conditioned reflex activity of the body is strengthened, metabolic processes are improved. Exercise therapy complexes are applied in a certain sequence. The load increases as the training increases.

Factors affecting blood flow to the liver are:

intra-abdominal pressure;

The activity of the digestive processes;

Intestinal peristalsis.

The outflow of blood from the liver is affected by:

Periodic increase in intra-abdominal pressure;

Position and movement of the diaphragm;

Full function of the right heart;

Body position (lying).

The best effect of physical therapy for liver diseases, in particular for the outflow of bile, is undoubtedly achieved in the initial prone position, while each of the 4 possible positions has its own characteristics (lying on the back, stomach, on the right side, on the left side).

The location of the biliary system in the abdominal cavity determines the best starting position lying on the left side. This ensures the free movement of bile in the gallbladder to its neck along the cystic duct. At the same time, this provision sharply limits the use of a variety of exercises necessary to improve the performance of other body functions.

The starting position lying on your back allows you to significantly expand the range of exercises for the abdominals, limbs and diaphragmatic breathing. However, the efficiency of using exercises in this initial position for the outflow of bile is somewhat lower than in the first variant.

The starting position lying on the stomach provides an increase in pressure in the abdominal cavity. Due to the formation of the so-called pressor pressure on the gallbladder, an additional effect arises that contributes to its emptying.

The initial position lying on the right side is unfavorable for the outflow of bile, since its entry into the neck of the gallbladder is difficult. However, in this position it is recommended to apply a number of exercises for diaphragmatic breathing. In this starting position, the excursion of the right dome of the diaphragm is significantly improved, which leads to an increase in blood circulation in the liver.

In the initial standing position, the possibility of using a wide range of gymnastic exercises is created. This position is less favorable for the outflow of bile, but it expands the area of ​​motor, breathing and gaming exercises. The latter is especially important when working with children.

The complex must be included in a certain sequence gymnastic exercises from various starting positions affecting different departments of activity human body. Wherein Special attention should be given to exercises of a specific nature, necessary for this particular disease.

In the matter of dosage, there can be no general recommendations. It must be done on a case by case basis.

Auxiliary physical activities are of great importance as general strengthening, increasing the vitality of the body, strengthening the nervous system and contributing to recovery. These include exercises with prolonged moderate physical activity (walking on flat terrain, health path, walking tours, close tourism). Under certain conditions, it is advisable to use swimming, skiing and skating, playing volleyball, tennis. Occupational therapy classes in the fresh air give a good effect - gardening, gardening, snow cleaning and others.

Along with a complex of gymnastic exercises, massage of the abdomen and intestines is of no small importance.

Regular use of physical exercises has not only therapeutic, but also important preventive value.

Below is a list of sample exercises.

Lying on your back

Raising a straight leg forward;

Alternately pulling the knee to the stomach;

Leading the leg to the side;

Raising both straight legs forward;

Bending both legs, pulling the knees to the stomach;

Leg movements reproducing movements when riding a bicycle;

Belly breathing (diaphragmatic), lying on the side;

Raising the leg to the side;

Leading the leg back - bending forward, pulling the knee to the stomach;

Counter swing movements of the arm and leg, sitting on a chair;

Turns of the body to the sides;

Torso to the sides;

Hands on the belt, take your elbows back - inhale, tilt forward - exhale;

Alternately bending and pulling the legs to the stomach;

Pulling both legs to the stomach;

Belly breathing (diaphragmatic);

Full breath while standing;

Walking. High knee walking

Standing at the support, swinging the legs forward, backward, to the sides;

Breathing belly and full;

Turns of the body to the sides with the abduction of the arm in the same direction;

Tilts of the torso to the side, forward and bending from various starting positions for the legs, with additional movement of the arms;

Squat;

Body rotation.

A set of exercises is compiled taking into account the disease, the individual characteristics of the patient, the principles of using physical exercises for therapeutic purposes. Exercises of a special nature are performed in combination with general developmental, respiratory exercises from various starting positions.

It must be remembered that the positive effect of physical therapy is achieved with systematic and regular classes for a long time under control.

2. Experimental part

2.1 Purpose, tasks and methodology of experimental work

Based on theoretical principles, we conducted an experiment, the purpose of which was to test the effect of the use of therapeutic physical culture in diseases of the digestive system.

The purpose of the experimental work is to reveal the significance of using the methods of physical therapy in diseases of the digestive system in children aged 5-7 years.

Tasks of experimental work:

To develop exercises aimed at improving the health status of children with diseases of the digestive system;

To check in practice the effectiveness of the influence of methods of physiotherapy exercises in children with diseases of the digestive system.

The experimental part of our study took place in Zatobolsk school No. 2. Two groups of 7 years old took part in the experiment: the experimental group (10 people) and the control group (10 people).

The modern system of school education in our country is undergoing major changes, which significantly increases the importance of the problem of maintaining and strengthening the health of schoolchildren.

The school is a place of active activity for children for 9-11 (12) years. Staying in school takes up a significant portion of a student's time budget, which increases from elementary to high school.

It becomes obvious the need to improve the health of schoolchildren within the framework of an educational institution with the active participation of pedagogical, medical workers, parents and the children themselves.

From a modern standpoint, the formation of the health of children in organized groups is based on the complex impact of measures for primary prevention of diseases, correction of risk states (i.e. such recommendations on lifestyle, nutrition, physical education, educational activities that minimize the likelihood of a risk state transition to disease), as well as the prevention of relapses and complications of chronic pathology.

The medical service of Zatobolsk School No. 2 is an integral part of the education system designed to preserve and improve the health of students. The work is based on strict observance of orders, instructions, guidelines.

The ill health of schoolchildren, especially the presence of long-term pathological conditions, congenital morphological disorders, the consequences of injuries lead to a limitation of life and social functions characteristic of their age, which can manifest itself in the limitation of physical independence and mobility, the ability to engage in ordinary activities, reduced opportunities for education, integration into society, to future professional activity and economic independence. Modern innovative pedagogical technologies are aimed at a significant improvement in the quality of education and are accompanied by a pronounced intensification of the educational process, an increase in the length of stay of children in an educational institution. Parallel to this, there is a process of deterioration in the health of children and adolescents.

Therefore, the search for new organizational forms of prevention and health promotion directly in the conditions of an educational institution, with the active participation of teachers, parents and the children themselves, becomes relevant. One of the ways to solve this problem is to organize a correction room in Zatobolsk school No. 2.

The organization of a school health and rehabilitation center in an educational institution allows:

Carry out activities to improve the health of children directly at the place of their education as part of the educational process;

Along with improving the health of students, solve the problems of rehabilitation aimed at minimizing the consequences of chronic diseases and improving the quality of life of children;

Ensure access to health services for all students;

It is more effective to solve the problems of health improvement, prevention and rehabilitation through the introduction of the principles of unified planning of medical, psychological, pedagogical and social events and joint activities of participants in the educational process (medical workers, teachers, students, parents).

The basis of the activity of the correction room of the Zatobolsk school No. 2 is the organizational and methodological support of the health-saving activities of the educational institution. To do this, the interaction of doctors, teachers, psychologists, social educators is organized. Parents are actively involved in the work, if necessary - specialists from other institutions and departments.

The purpose of the work of the correction room at Zatobolsk school No. 2 is to carry out preventive and rehabilitation medical, pedagogical and social measures aimed at improving the health of students and teachers.

Prevention of morbidity based on the implementation of the "Program of general strengthening measures and reducing the incidence of schoolchildren", which provides for the phased implementation of measures to prevent an unfavorable course of adaptation, fatigue, increased incidence of acute respiratory viral infections and influenza, digestive organs, etc.;

Rehabilitation treatment of children with chronic diseases of the respiratory system, digestion, kidneys, cardiovascular system, dental system, according to the recommendations of a pediatrician and specialists;

Corrective and health-improving measures for schoolchildren with disorders of the gastrointestinal tract, respiratory system, based on current recommendations for exercise therapy;

Promotion of healthy lifestyle skills among students and parents, formation of parents' responsibility for maintaining the health of the child. Use of scientific and methodological materials (lectures, memos, health information sheets), sports events, Health Days, etc.

The experiment took place in three stages:

At the first stage of our experiment, we identified the level of health in children with diseases of the digestive system.

At the second stage, they worked on the development and experimental testing of a system of physical exercises aimed at improving the condition of children with diseases of the digestive system.

The third stage is a re-examination on the problem of using therapeutic physical culture for diseases of the digestive system in children.

At the ascertaining stage, we used the following methodology for constructing recreational classes:

Health-improving physical exercises are carried out in the form of microcycles, which are divided into two periods: introductory (or preparatory) and main.

In the introductory (preparatory) period, the main task is to overcome reduced adaptation to physical activity, restore motor skills and physical performance (usually lagging behind age standards), achieve a desire to actively and systematically engage in physical exercises.

The main period is intended for the tasks of further restoration and strengthening of health. Physical exercises are aimed at maintaining the achieved results of rehabilitation and achieving a full recovery.

In the introductory period, exercises are used for all muscle groups, at a calm pace. Rhythmically, always in combination with breathing exercises and relaxation exercises. The load on the abdominal muscles should be limited.

In the main period, with systematic exercises, the total volume, amplitude and intensity of physical exercises gradually increase, exercises with weights are introduced, for coordination of movements, with the resistance of a partner, in balance, etc.

The combination principle: tension - relaxation - breathing exercises are observed without fail.

In the choice of initial positions (I. p.) for diseases of the gastrointestinal tract, preference is given to: lying on your back, on the right or left side, emphasis, kneeling.

Diaphragmatic breathing is performed in all of the listed starting positions. The number of exercises in the complex and the number of repetitions of each depends on the characteristics of the course of the disease and physical fitness.

Lesson scheme recreational gymnastics. Introductory part: heart rate calculation, breathing exercises, exercises for posture correction. inside feet, rolls from heel to toe, cross step, etc .; walking in combination with breathing exercises.. The main part is a set of special exercises, selected taking into account the form of the disease, physical fitness.. The final part: stretching exercises for working muscles, breathing exercises, exercises for relaxing muscle groups. Calculation of heart rate.

The lesson includes 75% of special exercises and 25% of general developmental and respiratory exercises. The physiological load curve is multi-peak. The starting positions in the exercises are different. The pace of the exercises is slow (TM), medium (TS), fast (TB). The ratio of breathing exercises to general developmental and special ones is 1: 3.

3. Research results

3.1 The content of experimental work on the use of therapeutic physical culture in diseases of the digestive system

During the experiment, at the ascertaining stage, we were faced with the task of identifying the state of health of children with diseases of the digestive system. With a disease of the digestive organs, a violation of reflex regulation occurs, pathological dominants and vicious (pathological) reflexes arise that distort the course of normal processes in the human body.

The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and functioning of any living organism. That's why physiotherapy is a very important element in the treatment of ulcerative processes.

It is already known that the implementation of dosed physical exercises, accompanied by positive changes in the functional state of the centers of the hypothalamic region and an increase in the level of basic life processes, causes positive emotions (the so-called psychogenic and conditioned reflex influence). This is especially applicable in case of peptic ulcer, when the neuropsychic state of patients leaves much to be desired (normalization of the dystonic phenomena expressed in patients from the nervous system). It should be noted the effect of physical activity on the nervous regulation of the digestive apparatus.

At regular performance physical exercises, as in the process of physical training, energy reserves gradually increase, the formation of buffer compounds increases, the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This leads to the activation of redox processes and to an increase in the stability of the acid-base balance, which in turn favorably affects the scarring of the ulcer (influence on the trophic and regenerative potencies of the gastrointestinal tissues).

The influence of physical exercises is determined by their intensity and time of application. Small and moderate muscle tensions stimulate the main functions of the gastrointestinal tract, while intense ones depress. There is a beneficial effect of exercise therapy on blood circulation and respiration, which also expands the functionality of the body and increases its reactivity.

The main tasks of exercise therapy are:

Regulation of the processes of excitation and inhibition in the central nervous system;

Normalization of the neuropsychological tone of the patient;

Improving the function of respiration, blood circulation and digestion, redox processes;

Counteraction to various complications accompanying peptic ulcer (adhesions, congestion, etc.);

Normalization of muscle tone (which is a powerful regulator of internal organs), increased muscle strength, proprioceptive sensitivity;

Development of the necessary motor qualities, skills and abilities (breathing, muscle relaxation, elements of autogenic training, coordination of movements, etc.).

Therapeutic gymnastics (LG) is one of the main forms of exercise therapy. In addition to general developmental exercises, special exercises are used for the abdominal and pelvic floor muscles, breathing exercises (static and dynamic), exercises in voluntary muscle relaxation (exercises for the abdominal muscles in the subacute period of the disease are excluded). Exercises in voluntary muscle relaxation reduce excitatory processes in the central nervous system, help accelerate the recovery processes of working muscles, lower the tone of not only the muscles involved in relaxation, but (reflexively) and smooth muscles of internal organs, including the stomach and intestines, relieve spasm of the intestines, pylorus stomach and other sphincters.

The therapeutic effect of LH will be much higher if special physical exercises are performed by muscle groups that receive innervation from the same segments of the spinal cord as the affected organ. These are exercises involving the muscles of the neck, trapezius, muscles that lift the scapula, large and small rhomboid, diaphragm, intercostal muscles, anterior abdominal wall, iliopsoas, obturator, muscles of the foot and lower leg. In diseases of the digestive system, the effectiveness of LH largely depends on the choice of starting positions, which allow differential regulation of intra-abdominal pressure.

In order to determine the condition of children with diseases of the digestive system, we conducted a set of exercises in the experimental and control groups, in total 20 people participated in the experiment.

Exercise 1. for diaphragmatic breathing

I. p. - lying on your back, legs straightened, arms along the body.

Calm breathing of the mixed type with a slightly prolonged exhalation phase 5-7 times. Clenching and unclenching the fingers into a fist. 10-12 times.

Flexion and extension of the legs in ankle joints. 10-12 times.

Bend the legs at the hip and knee joints; put your feet on the bed. Breathing is diaphragmatic. 5-7 times (Fig. 1). Alternately pulling up the legs on the bed, bending them at the knee and hip joints (feet slide on the bed). 4-5 times with each leg. Flexion and extension of the arms in the elbow joints. 6-8 times. Hands to shoulders; breeding elbows - inhale; return to i. p. - exhale. 4-5 times.

Rice. 1. Diaphragmatic breathing exercise.

Exercise 2. to activate intestinal motility

To activate intestinal motility and prevent adhesions, flexion of the legs at the knee and hip joints, swaying them to the sides, and turning to the side are used.

I. p. - lying on your back. Breathing of medium depth - a calm breath, a slightly elongated exhalation, 4-6 times.

Squeezing and unclenching the fingers at a slow pace, while unclenching, relax the muscles of the hands, 8-10 times.

Flexion and extension in the ankle joints simultaneously of the right and left legs. 10 - 12 times.

Alternate flexion and extension of the arms in the elbow joints of the right and left hands, 6-8 times each.

The left hand on the stomach, the right hand on the chest - deep breathing of the chest type, 6-7 times.

Circular movements in the ankle joints alternately with the right and left legs. 8-9 times.

Breeding the shoulders, trying to connect the shoulder blades - inhale, relax the muscles - exhale, 5-6 times.

Legs are bent, feet are on the floor. Slight swaying of the joined legs to the right and left. 5-6 times in each direction.

Turning the hands with palms up, slightly at the same time, spreading the shoulders, - inhale; return to i. p., relaxing the muscles of the hands, - exhale. 6-7 times.

A set of exercises in diaphragmatic breathing for the abdominal muscles

I. p. - lying on your back, hands on your stomach, elbows apart. Pressing hands on the stomach while performing a deep exhalation, return to and. p. - inhalation 4 - 6 times. The pace is slow.

I. p. - lying on your back, arms along the body, legs together; simultaneous bending of the legs with pulling them to the stomach. When pulling the legs - exhale, when straightening - inhale. 4-6 times. The pace is slow.

I. p. - lying on your back, hands above your head, legs bent, feet on the bed. slopes bent legs to the sides. Breathing is arbitrary. 5-7 times. The pace is average.

I. p. - lying on your back, arms along the body, legs together. Lifting up (up to 90 °) straightened legs alternately, then together. When lifting the legs - exhale, when lowering - inhale. 4-6 times. The pace is slow.

I. p. - lying on your back, hands on your belt, legs together. Transition from a lying position to a sitting position. When moving to a sitting position - exhale, when lowering to a prone position - inhale. 4-6 times. The pace is slow.

For patients suffering from high acidity of gastric juice, in order to normalize the acidity of the stomach and improve the functioning of the digestive system, we conducted a set of thirteen simple physical exercises below, which should be performed at a calm, smooth and unhurried pace.

To perform exercises from 1 to 7, you should take the starting position - sitting.

Exercise I. Torso twists. Hands to the sides - inhale, turn 90 ° to the right - exhale, return to the starting position - inhale; turn 90 ° to the left - exhale, return to the starting position - inhale. The pace is slow. Repeat on each side 3-6 times.

Exercise 2. Squeezing and unclenching the hands and bending and unbending the feet. Execute synchronously. The pace is average. Repeat 10-40 times. Breathing is even.

Exercise 3. Alternately raising and lowering either the right or the left leg. Raising a straight leg - exhale, lowering - inhale. The pace is slow. Repeat 3-6 times with each leg.

Exercise 4. Tilts of the torso to the right and left legs alternately. Tilt to the right - exhale, straighten up - inhale; tilt to the left - exhale, straighten - inhale. The pace is slow. Repeat 3-6 times on each side.

Exercise 5. Raise the right knee to the chest, hands to the shoulders - exhale, lower the knee and hands - inhale; raise the left knee to the chest, hands to the shoulders - exhale, lower - inhale. The pace is slow. Repeat 3-6 times for each side of the body.

Exercise 6. Squats. Sit down (back straight) - exhale, sit on a chair - inhale. The pace is slow. Repeat 4-12 times.

Exercise 7. Alternate relaxation of the muscles of the lower leg and foot, then the right, then the left leg. Breathing is even. Repeat 3-6 times.

To perform exercises from 8 to 10, the starting position is lying on your back.

Exercise 8. Raising your hands, clasp your fingers and turn your palms up. Pull up - and at the same time straighten your legs without lifting them off the floor - inhale. Return to the starting position - exhale. The pace is slow. Repeat 4-6 times.

Exercise 9. Turn on your right side. Raising your arm and pulling your leg back, bend - inhale and return to the starting position - exhale. The pace is slow. Repeat 3-8 times. The same on the left side.

Exercise 10. Alternately abducting the right, then the left straight leg up to the side. Taking the leg away, exhale, lowering - inhale. The pace is average. Repeat 3-8 times for each leg.

Exercise 11. Starting position - emphasis on the knees. Simultaneous lifting of arms and legs. We raise the right arm and right leg - inhale, lower - exhale; raise the left arm and left leg - inhale, lower - exhale. The pace is slow. Repeat 3-8 times for the left and right side of the body.

Exercise 12. Starting position - standing. Walking with gradual deceleration. Breathing is even.

Exercise 13. Starting position - sitting. Full slow breathing under the control of the hands. Put your right hand on your chest, left hand on your stomach. At the expense of one or two, we begin to perform a slow diaphragmatic breath, the diaphragm goes down, while the stomach protrudes. This movement is fixed by the left hand. On the count of three or four, we continue to take a full breath, but already with the chest. It fixes the right hand. The chest rises, the shoulders turn, and the head leans back a little. At the expense of five or six, we begin to make a slow diaphragmatic exhalation, the diaphragm goes up, and the stomach is drawn in. This movement is fixed by the left hand. On the count of seven or eight, we continue to exhale completely, but with the chest. It fixes the right hand. The chest drops, the shoulders come together, the head falls on the chest. On the count of nine to ten, try to hold your breath at full exhalation (In the future, you should try to gradually increase the breath-hold at full exhalation, but do not do it through force.) Repeat the exercise 3-5 times.

With good health and no pain in the stomach, patients suffering from hyperacid gastritis are advised to take walks, play volleyball and gorodki, ride a boat and bike (on a flat road). Shaking and sudden body movements should be avoided.

You should also not engage in heavy physical work, causing a sharp increase in intra-abdominal pressure, this can lead to exacerbation of gastritis.

4. Research results

The data obtained during the examination of children at the ascertaining stage made it possible to assess the level of the condition of children with diseases of the digestive organs of the experimental and control groups. The results are presented in table 3.

Table 3

The state of health of students in the control group before the experiment

Index	Excellent				Satisfactory
	Number of people		Number of people		Number of people
well-being
performance
School performance
Psycho-emotional state
Heart rate before class
VC (once a month, l)

Table 4

The health status of students in the experimental group before the experiment

Index	Excellent				Satisfactory
	Number of people		Number of people		Number of people
well-being
performance
School performance
Psycho-emotional state
Heart rate before class
VC (once a month, l)

Diagram 1

The state of health of students in the control group before the experiment

Diagram 2

The health status of students in the experimental group before the experiment

Analyzing the results of the first stage of the experiment, we found that the health status of children, both in the experimental and control groups, is at a low level. According to the results of the analysis, it can be noted that good health in both the experimental and control groups averaged 30%, which is a very low indicator. To improve the health of children with diseases of the digestive system, it is necessary to introduce corrective additional physical exercises.

The formative stage was of a corrective and health-improving character. At this stage, we organized a correctional and health-improving complex of breathing exercises according to the method of A.N. Strelnikova, also performed therapeutic exercises in the pool and in the fresh air.

Corrective and health-improving work with pupils of the experimental group at the second stage of the experiment is aimed at improving the health status of children with diseases of the digestive system.

A.N. Strelnikova found the most optimal option for a full breath, thus solving the key issue of healing breathing, which helps to get rid of many diseases.

The very first clinical studies of the effectiveness of A.N. Strelnikova showed that even in a completely unprepared person, after a few minutes of training, the vital capacity of the lungs increases by 10-15%. Of course, longer systematic sessions bring even more tangible positive results.

Gymnastics A.N. Strelnikova is also called "inspiration gymnastics". To train the respiratory muscles that carry out inhalation, it is proposed to create a certain resistance, which is achieved by compressing the chest with the hands during inhalation.

This type of breathing exercises should be done twice a day, in the morning and in the evening, making one thousand two hundred breaths-movements in one session. According to Alexandra Nikolaevna herself, after a short time a positive result is observed.

When performing a complex of respiratory gymnastics A.N. Strelnikova must comply with a number of conditions and rules.

During exercises, you need to think only about inhalation and monitor the synchronism of inhalation and movement, the correct rhythm (inhale every second). You need to inhale as much air as you inhale by itself.

Think only about inhaling through the nose.

This means that you only need to train the breath, which should be short, sharp and noisy - like clapping your hands.

Exhalation should be carried out after each breath independently and preferably through the mouth. Exhalation should not be delayed and "pushed out". Inhalation should be done as actively as possible and exclusively through the nose.

Exhalation must be carried out passively through the mouth, so that "the exhalation was neither seen nor heard."

It must be firmly understood that a noisy exhalation with this technique is unacceptable.

Inhalation should be done simultaneously with movements. Alexandra Nikolaevna herself says that in her gymnastics there is no breath without movement and movement without breath.

All breaths-movements must be performed at the pace and rhythm of the drill step.

Account in gymnastics A.N. Strelnikova is carried out only on 8 (the so-called "eight"). Of course, you need to count, not out loud, but mentally, to yourself.

Exercises can be performed while standing, sitting or lying down.

Exercise 1. "Palms"

The exercise is performed in a standing position. It is also possible to perform it sitting or lying down. In the main version, you should stand up straight, bend your elbows - while the elbows are lowered down. At the same time, you seem to be showing your palms to someone who is standing in front of you. This position of the body is sometimes called the "psychic pose".

Take noisy, short and rhythmic (observance of all three conditions is mandatory!) breaths through your nose, while clenching your palms into fists, i.e. making "grasping" movements.

It is necessary to take 4 sharp and rhythmic breaths in a row with the nose, in other words, “sniff” the nose 4 times. After that, lower your hands and take a break for 3-4 seconds. Then, after a pause, again take 4 short, noisy breaths; then again a pause of 3-4 seconds. You need to “sniff” your nose 24 times for 4 breaths.

It should be borne in mind that during the first lessons, slight dizziness may occur, which, however, passes rather quickly and does not pose a danger to health and well-being. If dizziness is more severe, then the proposed exercise must be performed in a sitting position. In this case, pauses should follow after every 4 breaths-movements, and the duration of pauses can reach 5 - 10 seconds.

Exercise 2

In the main version, the exercise is performed in a standing position. It can also be done sitting or lying down. The hands should be clenched into fists and pressed against the stomach at waist level. At the moment of inhalation, sharply push your fists down, as if "pushing up from the floor." In this case, the shoulders should be tense, straight arms stretch to the floor.

Then the hands return to their original position, to the level of the belt. The shoulders are relaxed, the exhalation is "gone".

Do not raise your arms above your waist. Take in a row not 4 breaths-movements, but 8. Then there is a pause lasting 3-4 seconds, after which again do 8 breaths-movements. In total, you need to do 12 times for 8 breaths-movements.

Exercise 3. "Pump"

Basic starting position: stand straight, legs slightly narrower than shoulder width, arms along the body. Make a slight bow, i.e. stretch your hands to the floor without touching it, and at the same time take a short and noisy breath through your nose - in the second half of the bow. The inhalation should end with the bow.

Then slightly rise (without straightening up), and again bow and short noisy breath "from the floor."

After that, pick up a stick (or, for example, a newspaper rolled up into a tube) and imagine that you are inflating a bicycle or car tire with a pump.

Forward bends should be performed rhythmically and easily, without straining or bending too low - a “bow to the waist” will be enough. The back should keep a rounded (and not straight!) shape, the head should be lowered.

It is necessary to "inflate the tire" at the pace of the drill step, 12 times in 8 breaths-movements. This exercise can be performed not only standing, but also sitting.

Tilts should be done barely noticeable, but always with a short and noisy breath through the nose. Exhalation must be done after each breath independently, without straining (i.e. passively) through the mouth, without opening it wide.

Exercise 4. "Cat" (squat with turn)

Stand straight, feet wide, slightly narrower than shoulder width; during the exercise, the feet should not come off the floor. Do a dance squat and at the same time turn your torso to the right - a short, sharp breath.

Then follows the same squat with a turn to the left, also accompanied by a noisy and short breath through the nose. Right left; inhale on the right - inhale on the left. Exhalations occur between breaths on their own, involuntarily.

The knees should be slightly bent and straightened; squatting should be light and springy; no need to go deep. At the same time, with your hands, perform grasping movements to the right and left at the level of the belt. The back should be perfectly straight; rotation is carried out only at the waist. It is necessary to perform 12 times for 8 breaths-movements.

This exercise can also be done while sitting in a chair or lying in bed. It all depends on the health of the patient.

Exercise 5. "Hug your shoulders" (inhale on chest compressions)

Stand straight, arms bent at the elbows and raised at shoulder level. Sharply move your hands towards each other to failure, as if hugging your shoulders. And at the same time with each "hug" sharply "sniff" your nose. Hands at the moment of "embrace" go parallel to each other, and not crosswise; in no case do not change them (it does not matter which hand is on top - right or left). Do not spread your arms wide to the sides and do not strain.

Having mastered this exercise, at the moment of the oncoming movement of the hands, you can slightly tilt your head back - "inhale from the ceiling." It should be performed 12 times for 8 breaths-movements. Exercise "Hug your shoulders" can also be done while sitting or lying down.

If the state of health does not allow you to perform this exercise in full, then you can do not 8 breaths-movements in a row, but 4 breaths-movements or even 2, then a pause of 3-5 seconds follows, and again 2 or 4 breaths. movement.

The initial lying position is recommended during the period of exacerbation and immediately after the exacerbation of the disease as the most sparing, contributing to the least functional shifts, providing the best conditions for performing breathing exercises (lying on your back with bent legs), voluntary muscle relaxation. These starting positions are convenient for performing exercises for the abdominal muscles and pelvic floor.

Anatomical and topographic relationships of the gallbladder, common bile duct and duodenum allow us to recommend and. n. lying on the left side, standing on all fours, in which the outflow of bile towards the neck of the bladder and the ampoule is carried out under the influence of hydrostatic pressure. In addition, the outflow of bile in these initial positions is accelerated by an increase in intra-abdominal pressure during full breathing with an emphasis on the diaphragm and some participation of the abdominal muscles.

I. p. kneeling (on all fours) are used if necessary to limit the impact on the abdominal muscles, cause mechanical movement of the stomach and intestinal loops; And. items standing and sitting are used for the greatest impact on the digestive organs.

LH in the aquatic environment is carried out in pools with fresh or mineral water. Exercises are performed from and. n. lying with floating devices or at the handrail, sitting on a hanging chair, standing and in motion. The duration of the lesson is from 20 to 40 minutes. Water temperature 24-26°C. The course of treatment is 12-15 procedures. Classes are carried out both individually and in small groups.

Terrenkur in the fresh air trains and hardens the body, normalizes the psycho-emotional sphere. This is a natural physical exercise - walking. You can dose physical activity by changing the distance, the angle of elevation, the pace of walking (passing a given distance in a certain period of time), the number of stops for rest and their duration, the use of breathing exercises during walking and rest, the appointment of 1-2 or 3 walks per day, alternating training days with rest days.

Sports games, from a physiological point of view, are complex forms of acyclic muscular activity, which makes their dosage much more difficult. This shortcoming is made up for by their high emotionality. Game activity allows you to turn on and use the large reserve capabilities of the cardiovascular system.

LH is used after the acute period of the disease. Exercises should be done carefully if they aggravate the pain. Complaints often do not reflect the objective state, and the ulcer can progress with subjective well-being (disappearance of pain, etc.). In this regard, in the treatment of patients, the abdominal area should be spared and very carefully, gradually increase the load on the abdominal muscles. It is possible to gradually expand the patient's motor mode by increasing the total load when performing most exercises, including exercises in diaphragmatic breathing and exercises for the abdominal muscles.

LH classes are first carried out in relation to bed rest. In the first lessons, it is necessary to teach the patient abdominal breathing with a small amplitude of abdominal wall oscillations. These exercises, causing slight changes in intra-abdominal pressure, help to improve blood circulation and gentle massage of the abdominal organs, reduce spastic phenomena and normalize peristalsis. Movements in the large joints of the limbs are performed first with a shortened lever and a small amplitude. You can use exercises in static tension of the muscles of the belt of the upper limbs, abdominals and lower limbs. It is necessary to turn in bed and move into a sitting position calmly, without significant stress.

The duration of the LH classes is 8-12 minutes.

With a noticeable subsidence of pain and other phenomena of exacerbation, the disappearance or decrease in the rigidity of the abdominal wall, a decrease in soreness and an improvement in the general condition, exercises from and are prescribed. p. lying, sitting, standing, kneeling in an emphasis are performed with a gradually increasing effort for all muscle groups (with the exception of the abdominal muscles), with incomplete amplitude, at a slow and medium pace. Short-term moderate tension of the abdominal muscles is allowed in the supine position. Gradually, diaphragmatic breathing deepens.

Duration of LH classes 15-18 min.

After the disappearance of pain and other signs of exacerbation, in the absence of complaints and general satisfactory condition, a free regimen is prescribed. In LH classes, exercises are used for all muscle groups (sparing the abdominal area and excluding sudden movements) with increasing effort from various starting positions. They include exercises with dumbbells (0.5-2 kg), stuffed balls (up to 2 kg), exercises on the gymnastic wall and bench. Diaphragmatic breathing is carried out with maximum depth. Walking is brought up to 2-3 km per day, walking up the stairs - up to 4-6 floors, outdoor walks are desirable. The duration of the LH class is 20-25 minutes.

In the conditions of a correctional room at Zatobolsk school No. 2, where patients are treated during remission, the volume and intensity of LT classes increase: general strengthening, breathing exercises, exercises for coordination of movements are widely used, mobile and some sports games are allowed (badminton, table tennis), relay races. In the LH procedure, we exclude power, speed-strength exercises, static efforts and stresses, jumps and hops, performing exercises at a fast pace.

With the children of the experimental group, we carried out exercises according to the following scheme of motor modes:

Mode with little physical activity (sparing).

The mode with low physical activity (sparing) is used to restore adaptation to the loads of the extended mode; stimulation of metabolic processes; fight against congestion in the abdominal cavity; normalization of regenerative processes; a positive effect on the psycho-emotional sphere of patients and a moderate increase in the adaptation of the cardiovascular system to increasing physical exertion. With a sparing regime, periods of rest prevail over periods of load.

Contents of the regimen: include balneo- and physiotherapy procedures. Morning hygienic gymnastics is carried out by a small-group method with a small load, lasting 10-15 minutes, the density of the LH class is 40-50%. LH is carried out by a small group method or individually, the duration is 20-25 minutes, the density of the lesson is 50%. Dosed walks on flat terrain with a length of 0.5-1.5 km 1-2 times a day with an interval for rest of at least 1-2 hours, at a pace characteristic of the dynamic stereotype of the patient. Independent physical exercises 1-2 times a day for 6-8 special exercises. Sedentary games (croquet, bowling alley) up to 30 minutes. Indications for prescribing the regimen: diseases of the gastrointestinal tract in the stage of fading exacerbation, poor general condition (severe weakness, fatigue).

Mode with average physical activity (sparingly training).

Purpose: restoration of adaptation to training loads.

Dosed walks at a slow and medium pace with a length of 6 km and an elevation angle of up to 10 ° 1-2 times a day. It is allowed to play croquet, bowling alley, gorodki, table tennis, badminton according to simplified rules with a small load, on average up to 40-60 minutes. Sports exercises (water and winter sports) with a small load, dosed rowing, horseback riding, skiing.

Indications for prescribing the regimen: chronic diseases of the gastrointestinal tract in the phase of complete remission, 1-3 years after gastric resection. The mode is also shown to patients transferred from a sparing regimen.

Mode with great physical activity (training).

Purpose: to maintain performance at the highest possible level.

The content of the regimen: in the daily regimen, balneo- and physiotherapy procedures are provided. Morning hygienic gymnastics by group method with an average load (15-20 minutes, motor density 60-70%). LH with a heavy load according to a special technique (30-45 minutes, motor density 60-70%). Self-study of patients with special exercises 3-4 times a day. Dosed walks at a slow pace along routes from 10 to 20 km long with an elevation angle of up to 20 °. Participation in competitions according to simplified rules is allowed. Sports exercises (water and winter sports) with an average load. Physical activity prevails over rest and relaxation.

Indications for prescribing the regimen: chronic diseases of the gastrointestinal tract in the phase of stable remission with stable compensation of functions. The regimen is also prescribed to patients transferred from a sparing training regimen in the second half of the course of treatment, subject to positive dynamics. The duration of the patient's stay in one or another mode of movement is not determined by a certain number of days. The attending physician transfers the patient from one mode to another based on favorable changes in his clinical condition with the adaptation of the cardiovascular system and the body as a whole to the previous mode of movement. It is not necessary to prescribe all forms of exercise therapy for the new regimen: the training effect can be achieved even with an increase in load in only one form of exercise therapy.

General tonic training regimen of exercises.

Assign after the disappearance of pain and exacerbation in the absence of complaints about the main signs of the manifestation of the disease with a general improvement in the condition. Terms of appointment - in 20-26 days.

Target setting: restoration of the patient's adaptation to the loads of the extended mode. Increasing stimulation of metabolic processes, impact on the regulation of excitation and inhibition processes in the cerebral cortex, impact on the normalization of autonomic functions. Fight congestion in the abdominal cavity. Promoting regenerative processes in the gastrointestinal tract.

Characteristics of the applied physical exercises. From the initial positions lying, on the side, etc., gradually expand the movements to full amplitude for large joints at a slow and medium pace. Includes exercises for all abdominal muscles, performed at a slow pace with limited amplitude and with the exception of sudden movements.

Gradually increases (up to about 40-50% of max.) And the intensity of resistance exercises for the muscles of the shoulder girdle and intercostal muscles with the aim of a reflex effect on the digestive organs. To combat congestion, a good effect is given with diaphragmatic breathing from various starting positions, which is brought to a great depth, alternating with chest and full breaths; a more frequent change also helps. etc., exercises, games and loads with their complication. Gradually, more difficult exercises for attention are included in the classes. At the same time, the density of classes remains not above average. Walking is brought up to 4-5 km per day. With general good health and no pain, ball games (volleyball, etc.) are allowed, taking into account individual reactions lasting no more than 25-35 minutes. The inclusion of various types of games in the course helps to maintain interest and increases the production of positive emotions during general physical activity.

In the course of the entire course, we point out to the patient the positive changes achieved in his condition and physical development, suggest that stomach disorders are minor and easily corrected (psychological impact). Exercise therapy is effective only under the condition of a long, systematic training with a gradual increase in the load both in each of them and throughout the course. A strict sequence in increasing the load and its individualization are the main conditions for all classes. This should take into account the condition, the reaction of students, the characteristics of the clinical course, concomitant diseases and physical fitness of students. Another thing is also important: by doing physical exercises, the patient himself actively participates in the healing process, and this has a beneficial effect on his psycho-emotional sphere.

Control stage. At this stage, we have summed up our entire study. The children of the experimental and control groups were re-examined. The results of the study are shown in tables (3,4,).

Table 5

The health status of students in the control group after the experiment

Index	Excellent				Satisfactory
	Number of people		Number of people		Number of people
well-being
performance
School performance
Psycho-emotional state
Heart rate before class
VC (once a month, l)

Table 6

The health status of students in the experimental group after the experiment

Index	Excellent				Satisfactory
	Number of people		Number of people		Number of people
well-being
performance
School performance
Psycho-emotional state
Heart rate before class
VC (once a month, l)

Diagram 3

The health status of students in the control group after the experiment

Diagram 4

The health status of students in the experimental group after the experiment

From the analysis of the control study, we see a significant difference between the experimental and control groups. In the control group, the results of the health status of children remained at the same level, and in the experimental group, the well-being of children improved by almost 40%, working capacity increased, the psycho-emotional state improved by 20%, sleep returned to normal - 100%. In general, the health status of children in the experimental group improved by 30-40%.

Thus, it can be concluded that the introduction of a correctional and health-improving complex of breathing exercises, exercises in the fresh air and in the pool into therapeutic physical culture contributes to improving the health of children with diseases of the digestive system. Respiratory exercises in diseases of the gastrointestinal tract have a local effect on the abdominal organs by changing the position of the diaphragm - when inhaling (the diaphragm descends) and exhaling (rises). This causes an increase and decrease in intra-abdominal pressure, which improves digestion and increases intestinal motility - as a result, the movement of feces is accelerated. In addition, breathing exercises enrich the blood with oxygen, favorably affecting the redox processes in the digestive organs, and contribute to the rapid healing of ulcers (stomach, duodenal ulcer) and erosion. Our pilot study confirms our hypothesis: the use of a corrective and health-improving complex of exercises in physical education helps to improve the health of children with diseases of the digestive system.

conclusions

Today, the need to improve the health of schoolchildren within the framework of an educational institution with the active participation of pedagogical, medical workers, parents and the children themselves is becoming obvious.

From a modern standpoint, the formation of the health of children in organized groups is based on the complex impact of measures for primary prevention of diseases, correction of risk states (i.e. such recommendations on lifestyle, nutrition, physical education, educational activities that minimize the likelihood of a risk state transition to disease), as well as the prevention of relapses and complications of chronic pathology.

The medical service at school is an integral part of the education system, designed to preserve and improve the health of students.

The medical service at the school provides:

Gradual implementation of measures to prevent the unfavorable course of adaptation, fatigue, increased morbidity among students;

Rehabilitation treatment of children with chronic diseases of the respiratory, digestive, kidney, cardiovascular system, dental system, according to the recommendations of a pediatrician and specialists.

Corrective and recreational activities for schoolchildren with disorders of the musculoskeletal system, gastrointestinal tract, respiratory system, with myopia based on current recommendations for exercise therapy.

Therapeutic exercise is an integral part of general physical education and one of the most important methods of complex treatment of diseases of the gastrointestinal tract, as well as an effective means of preventing exacerbations with the correct construction of classes and the whole complex. The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and functioning of any living organism. Therefore, exercise therapy is a very important element in the treatment of diseases of the gastrointestinal tract.

With regular exercise, energy reserves gradually increase, the formation of buffer compounds increases, the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This leads to the activation of redox processes and an increase in the stability of the acid-base balance.

The use of therapeutic physical culture in diseases of the digestive system is substantiated by experimental data on the reflex effect of motor activity on secretion, gastric motility and the activity of the salivary glands.

Normalization of the secretory and motor functions of the stomach and intestines in children is possible with the dosage of physical activity, taking into account the nature of secretion and peristalsis disorders. Moderate physical activity (calm walking, light gymnastic exercises, etc.) increases the excitability of the cerebral cortex, the tonic activity of the sympathetic nervous system, and the motor-evacuation function of the stomach. Intense physical activity (strength exercises, long running, etc.) inhibits gastric secretion and motor function of the stomach and intestines. Walking for 30 minutes immediately after a meal stimulates an increase in acidity and increases pain. In the phase of complete remission, patients with peptic ulcer, like healthy individuals, react to the same physical activity by inhibiting the acid-forming function of the stomach.

The purpose of using physical exercises is to improve the neuropsychic state of patients, normalize the function of the autonomic nervous system, and improve the motor function of the intestine. It is advisable to include in the complex of exercises abdominal breathing with active movement of the diaphragm, flexion, extension, tilts and turns of the body; hip flexion and knee joints with rotation of the hips to the outside; flexion, extension, pronation and supination of the feet; finger movements moan. The optimal starting positions are lying on your back, on your stomach, on your side, knee-wrist, knee-elbow. Exercises are performed without tension or with weak effort, rhythmically, at an average and slow pace, 8-15 times.

The disease suppresses and disorganizes motor activity - an indispensable condition for the normal formation and functioning of any living organism. Therefore, exercise therapy is a very important element in the treatment of ulcerative processes.

It is already known that the implementation of dosed physical exercises, accompanied by positive changes in the functional state of the centers of the hypothalamic region and an increase in the level of basic life processes, causes positive emotions (the so-called psychogenic and conditioned reflex influence). This is especially applicable in case of peptic ulcer, when the neuropsychic state of patients leaves much to be desired (normalization of the dystonia phenomena expressed in patients from the nervous system. The effect of physical activity on the nervous regulation of the digestive apparatus should be noted.

With regular exercise, as in the process of physical training, energy reserves gradually increase, the formation of buffer compounds increases, the body is enriched with enzyme compounds, vitamins, potassium and calcium ions. This leads to the activation of redox processes and to an increase in the stability of the acid-base balance, which in turn favorably affects the scarring of the ulcer (influence on the trophic and regenerative potencies of the gastrointestinal tissues).

The influence of physical exercises is determined by their intensity and time of application. Small and moderate muscle tensions stimulate the main functions of the gastrointestinal tract, while intense ones depress.

There is a beneficial effect of exercise therapy on blood circulation and respiration, which also expands the functionality of the body and increases its reactivity.

In the prevention and complex treatment of diseases of the gastrointestinal tract, physical therapy occupies an important place - it has a strengthening and regulating effect on the nervous system and the functions of the digestive organs. In addition, exercise therapy locally affects the abdominal press and intra-abdominal organs: stomach, intestines, liver, spleen, kidneys. The result of the impact of physical exercises depends on their type, dosage, rhythm and pace of execution, on the stage of their application, the duration of the course, as well as on their combination with diet and other therapeutic agents.

Thus, exercise therapy has a positive effect on the abdominal organs, stimulates the regulatory mechanisms of the digestive system.

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PHYSICAL CULTURE AND SPORT

Therapeutic exercise for diseases of the digestive system

Chronic gastritis

Biliary dyskinesia

Colitis

Diseases of the digestive system occupy a significant place in clinical medicine. Diseases of the digestive system often affect people of the most able-bodied age, causing a high rate of temporary disability and disability. The location and general anatomy of the main parts of the digestive tract are shown in Fig. Organs of the thoracic and abdominal cavities. The close anatomical and physiological relationship between the digestive organs makes it impossible to separately treat one or another organ in case of its disease.

Organs of the thoracic and abdominal cavities

1 - larynx, 2 - windpipe, 3 - upper lobe of the left lung, 4 - pulmonary trunk, 5 - heart, 6 - diaphragm, 7 - stomach, 8 - spleen, 9 - transverse colon, 10 - small intestine, 11 - sigmoid colon, 12 - bladder, 13 - caecum, 14 - ascending colon, 15 - gallbladder, 16 - liver, 17 - upper lobe of the right lung, 18 - aorta, 19 - superior vena cava, 20 - shoulder head vein; 21 - right internal jugular vein; 22 - right common carotid artery.

Chronic gastritis

Chronic gastritis- inflammatory change in the gastric mucosa of an endogenous or exogenous nature.

Characteristic signs of chronic gastritis are: an unpleasant taste in the mouth, sour belching, nausea, especially in the morning, heaviness in the epigastrium, flatulence and pain resembling ulcers; with gastritis with secretory insufficiency, diarrhea is possible.

An important role in the occurrence of chronic gastritis is played by alcohol abuse, smoking, drugs, malnutrition (a chronic lack of food of animal proteins, vitamins B, A, C, E) and irregularity (malnutrition) of food intake. Often the cause of chronic gastritis is the performance of intense physical activity, including sports.

The most common chronic gastritis with high acidity occurs in men.

For treatment, diet therapy, drug therapy, vitamins and other means are used. Exercise therapy, walking, skiing, swimming, cycling, sauna (bath), etc. are recommended. Therapeutic gymnastics includes general developmental and breathing exercises, relaxation exercises. With a pain symptom, cryomassage of the abdominal wall is indicated. However, exercises for the abdominal muscles are contraindicated. Useful walks, contrast showers, remedial gymnastics lying (breathing exercises, exercises for the distal lower extremities).

Biliary dyskinesia

This disease is characterized by a persistent functional disorder of the bile ducts, bile ducts, their sphincters, leading to stagnation of bile.

With dyskinesia of the gallbladder and bile ducts, there are no inflammatory elements in all portions of bile, but an increase in its relative density and viscosity is often noted. There is a slight pain in the right hypochondrium, as well as dyspeptic phenomena in the form of a feeling of heaviness in the abdomen, belching, a feeling of bitterness in the mouth.

Approximate complex of therapeutic exercises for biliary dyskinesia

1. Walking in place and in motion with high hips - 1-2 minutes. Breathing is free.

2. I. p. - standing, hands on the belt. Raise your arms up, take your right (left) leg to the side - inhale. Lower your arms down, put your foot - exhale. 4-6 times.

3. Walking in a crouch - 1-2 minutes.

4. I. p. - standing, hands to shoulders. Raise your arms up, take your left (right) leg back, bend - inhale, return to and. p. - exhale. 4-6 times.

5. I. p. - standing, hands up. Pull the right (left) knee to the stomach with your hands - exhale; return to i. p. - inhale. 6-8 times.

6. I. p. - standing, hands on the belt. Rotation of the body to the sides. 4-6 times in each direction.

7. Walking in place and on the move. Breathing is free. 1-2 min.

8. I. p. - lying on your back. Alternately bend the left (right) leg at the knee and hip joint and raise the right hand up - inhale. 6-8 times with each leg.

9. I. p. - lying down, legs bent at the knee and hip joints, arms to the sides. Turning legs left and right. In each direction 4-8 times.

10. I. p. - lying down, arms along the body. Raise your hands up - inhale, hands down - exhale. 5-6 times.

11. I. p. - lying on your back, arms along the body, legs lift up. Diaphragmatic breathing (“breathe” with the stomach). 4-6 times. Rest 1-2 minutes, lying on your back.

12. I. p. - lying on the left side, left hand under the head. Take the right leg back, and the arm up - inhale. Lower your hand and press your knee to your stomach - exhale. 4-8 times.

13. I. p. - standing. Hands up - inhale; sit down, clasping your knees - exhale. 4-8 times.

14. Walking - 1-2 minutes. Breathing is free.

Peptic ulcer of the stomach and 12 duodenal ulcer

The development of this pathology is facilitated by neuropsychic overstrain, causing dysfunction of the stomach and intestines, poor nutrition, smoking, alcohol abuse, hereditary predisposition and a number of other factors.

Peptic ulcer of the stomach and duodenum is characterized by the presence of complaints of acid belching and heartburn, nausea, etc. The main symptom of the disease is pain in the epigastric region or in the right hypochondrium, which are especially aggravated in spring and autumn. Mild excitability, irritability, sleep disturbance are also noted, more often excitation processes from the cerebral cortex prevail.

Physical education and hardening are carried out outside the stage of exacerbation. Physiotherapy exercises (see the complex), walking, swimming, skiing, etc., hardening (air baths, showers, rubbing, etc.), massage of the back and lower extremities are shown.

Diseases of the digestive system occupy a significant place in clinical medicine. Diseases of the digestive system often affect people of the most able-bodied age, causing a high rate of temporary disability and disability.

The location and general anatomy of the main parts of the digestive tract are shown in Fig. 83. The close anatomical and physiological relationship between the digestive organs makes it impossible to separately treat one or another organ in case of its disease.

In diseases of the digestive system, changes in motor, secretory and absorption functions are observed. Pathological processes of the gastrointestinal tract are closely interconnected and are caused by a violation of the nervous regulation.

As a result of a violation of the secretory function, gastritis, gastric and duodenal ulcers, etc. develop, and with a disorder of motor function - colitis, constipation, etc.

The main means of treating diseases of the digestive system are diet therapy, medicines, massage, movements (exercise therapy, moderate physical activity, etc.), physio- and hydrotherapy. Exercise therapy in this pathology has a general tonic effect, debugs neurohumoral regulation, stimulates blood and lymph circulation in the abdominal organs, strengthens the abdominal muscles, contributes to the normalization of evacuation and motor functions of the intestine, etc.

The result of the impact of physical exercises depends on their type, dosage, rhythm and pace of performance, on the stage of their application, the duration of the course, as well as on their combination with diet and other therapeutic agents.

Studies have shown that moderate physical education normalizes the secretory and evacuation functions of the stomach, and intense physical training, on the contrary, depresses. The use of special exercises and segmental-reflex massage contributes to the normalization of impaired functions. So, exercises for the muscles of the abdominal wall and pelvic floor are good for chronic colitis, cholecystitis, dyskinesia, etc., and breathing exercises have a “massaging” effect on internal organs, improving blood and lymph circulation in the abdominal cavity. At the same time, studies have shown that exercises for the abdominal press sharply increase intra-abdominal pressure, so they are contraindicated in patients with exacerbation of gastric and duodenal ulcers, with spastic colitis. Such patients benefit from breathing exercises, relaxation exercises lying on their back with legs bent at the knee and hip joints, or in the knee-elbow position.

Rice. 83. Organs of the thoracic and abdominal cavities: 1 - larynx; 2 -

windpipe; 3 - upper lobe of the left lung; 4 - pulmonary trunk; 5 - heart; b- diaphragm; 7 - stomach; 8 - spleen; 9 - transverse colon; 10 - small intestine; 11 - sigmoid colon; 12 - bladder; 13 - cecum; 14 - ascending colon 15 - gallbladder; 16 - liver; 17 - upper lobe of the right lung; 18 - aorta; 19 - brachiocephalic vein; 20 - left subclavian vein; 21 - left internal jugular vein; 22 - right common carotid artery
Massage facilitates the release of bile (V.I. Dubrovsky, 1973, 1985) by increasing blood and lymph circulation in the liver and abdominal organs. Physical exercises contribute to the normalization of impaired functions in dyskinesia of the gastrointestinal tract and biliary tract.

Thus, exercise therapy and massage have a positive effect on the abdominal organs, stimulate the regulatory mechanisms of the digestive system.
Gastritis
Gastritis - inflammation of the gastric mucosa, can be acute and chronic. Acute gastritis is most often the result of taking substances that irritate the mucous membrane, more often alcohol, the use of low-quality or unfamiliar food, some drugs, food poisoning, acute poisoning.

In mass surveys of the population of industrialized countries, approximately 50% of people, many of whom did not complain about changes in the stomach, show signs of gastritis (V.Kh. Vasilenko, A.P. Grebnev; K. Villako et al., et al. ).

It has also been established that oxygen starvation of the body, being an important pathogenetic factor, has a great influence on the course and outcome of many internal diseases. Another thing is also known: the glands of the gastric mucosa are very sensitive to oxygen deficiency. Prolonged hypoxia leads to atrophy of the gastric mucosa with the development of enzymatic and secretory insufficiency. Hypoxia of the gastric mucosa is aggravated by blood redistribution during heavy physical exertion. The main portion of the blood is sent to the vital organs (brain, heart, liver, and also to the muscles), while the exchange blood flow in the abdominal organs is reduced (M.M. Mirrakhimov, 1975).

Thus, hypoxia is the cause of chronic atrophic gastritis (E.K. Rychkova, T.N. Sauchikova, 1973, etc.).

^ Gastritis chronic - an inflammatory change in the gastric mucosa of an endogenous or exogenous nature.

Characteristic signs of chronic gastritis are: an unpleasant taste in the mouth, sour belching, nausea, especially in the morning, heaviness in the epigastrium, flatulence and pain resembling ulcers; with gastritis with secretory insufficiency, diarrhea is possible.

An important role in the occurrence of chronic gastritis is played by alcohol abuse, smoking, drugs, malnutrition (a chronic lack of food of animal proteins, vitamins B, A, C, E) and irregularity (malnutrition) of food intake. Often the cause of chronic gastritis is the performance of intense physical activity, including sports.

Gastritis is subdivided (taking into account the secretory function of the stomach) into gastritis with secretory insufficiency; gastritis with increased secretion and acidity; gastritis with normal secretory function. Athletes often have gastritis with increased secretion and acidity, which often turns into peptic ulcer.

The most common chronic gastritis with high acidity occurs in men. Symptoms: heartburn, sour belching, burning sensation, pressure and heaviness in the epigastric region. At a palpation of a stomach moderate morbidity is noted; sometimes there is a neurasthenic syndrome (increased irritability, poor sleep, fatigue, etc.).

For treatment, diet therapy, drug therapy, vitamins and other means are used. Exercise therapy, walking, skiing, swimming, cycling are recommended. With spa treatment: swimming, walking and running along the seashore, games on the seashore, diet, oxygen cocktail, exercise therapy, etc.

LH includes general developmental and breathing exercises, relaxation exercises. With a pain symptom, cryomassage of the abdominal wall is indicated. However, exercises for the abdominal muscles are contraindicated. Useful walks, contrast showers, LH lying down (breathing exercises, exercises for the distal lower extremities).

Massage objectives: to provide analgesic effect; normalize the secretory and motor functions of the stomach; activate blood and lymph circulation; eliminate the usual venous congestion; stimulate bowel function.

Massage technique. Massage of the abdomen is performed with maximum relaxation of the muscles of the abdominal wall. Planar stroking, rubbing, kneading the muscles of the abdominal wall, oblique abdominal muscles, as well as vibration are used. Then, along the course of the large intestine (starting from its ascending part), stroking is carried out with the fingertips right hand. Stroking techniques are repeated 4-6 times, after which several superficial circular strokes are made to give the abdominal wall a rest, and then tapping with the fingertips along the intestine and shaking it to affect its wall. Finish the massage of the abdominal wall with planar stroking and diaphragmatic breathing. The duration of the massage is 10-15 minutes.
^ Peptic ulcer of the stomach and duodenum
Factors contributing to the occurrence of peptic ulcer are various disorders of the nervous system; in a number of patients, hereditary predisposition, as well as neuropsychic overstrain of the central nervous system and its peripheral departments, nutritional errors, alcohol abuse, spicy food, chronic diseases of the gastrointestinal tract and other factors may be important.

Peptic ulcer of the stomach and duodenum in most patients was preceded by complaints of sour eructation and heartburn, nausea and other symptoms. But the main symptom of peptic ulcer is pain, which is especially intensified in spring and autumn. There are also slight excitability, irritability, sleep disturbance.

Comprehensive rehabilitation includes: massage, LH, diet therapy, physiotherapy and hydrotherapy, drinking mineral water and other therapeutic agents. LH (Fig. 84) is used during remission, the absence of dyspeptic and pain phenomena, with normal ESR, hemoglobin and leukocytes, as well as in the absence of occult blood in the feces. With the appearance of pain in the epigastric region, cryomassage is indicated, excluding techniques that cause muscle tension in the abdominal press. Exercises are performed lying down, at a slow pace and monotonous rhythm, accompanied by music. Duration 8-10 minutes, then taking a contrast shower.

Rice. 84. An approximate complex of LH in gastric ulcer and

duodenum
Recommended sanatorium treatment (Crimea, etc.), during which: walks, swimming, games; in winter - skiing, skating, etc.; diet therapy, drinking mineral water, taking vitamins, UV radiation, contrast showers.

In the phase of complete remission, LH is performed standing, sitting and lying down. They include exercises with a gymnastic stick, balls, dumbbells, exercises on simulators (or block devices), visiting a sauna (bath) and long walking at a calm pace.

Massage tasks: normalization of the psycho-emotional state, sleep, pain relief, acceleration of oxidative-metabolic processes and regeneration of the mucous membrane.

Massage technique. Massage of the collar region, back (segmental effect on the cervicothoracic spine) and abdominal wall. Massage of the abdominal wall is carried out during the period of remission. Chopping, tapping and vibration are excluded. The duration of the massage is 10-15 minutes. Course 15-20 procedures. 3-4 courses per year. Massage is preferably carried out in a darkened room, accompanied by color music; then - taking an oxygen cocktail (the cocktail should include various herbal decoctions).
^ Dyskinesia of the biliary tract
Dyskinesia of the biliary tract is characterized by a disorder of the motor function of certain parts of the biliary system, including the sphincter of Oddi. This is facilitated by various vegetative-nervous disorders. Biliary dyskinesia is initial stage in the pathogenesis of other diseases of the biliary tract, contributing to the formation of gallstones and the development of infection. Often combined with other functional disorders - duodenal dyskinesia, changes in the function of the stomach, intestines, pancreas.

With a spastic, or hyperkinetic, gallbladder, short-term pains are noted in the right hypochondrium and epigastric region.

For an atonic, or hypokinetic, gallbladder, dull, long-term pain after eating is characteristic, aggravated by a long sitting position of the patient. The evacuation of bile is slow.

Dyskinesia is quite common among athletes (cyclists, racers, runners, stayers, etc.).

^ For hyperkinetic form of dyskinesia characterized by paroxysmal pain (biliary colic) that occurs after physical exertion (overload) and is often accompanied by nausea, vomiting, impaired stool, as well as irritability, headache, deterioration in general condition.

^ Hypokinetic dyskinesia It is manifested by recurrent pains and a feeling of fullness in the right hypochondrium, sometimes by dyspeptic phenomena and a deterioration in the general condition.

Comprehensive treatment includes massage, LH, diet therapy, mineral water drinking, physio- and hydrotherapy, drug therapy, herbal medicine and other therapeutic agents.

LH consists of general developmental and breathing exercises; the choice of starting position is of great importance. Best conditions for blood circulation in the liver, the formation and secretion of bile are created in the supine position. To enhance the effect of the diaphragm, you can apply breathing exercises while lying on your right side, since in this case the excursion of its right dome increases. In addition, LH is carried out in an emphasis on the knees, as well as knee-elbow, which help to relax the abdominal press and unload the spine, allow you to perform exercises with raising and adducting the legs without sudden changes in intra-abdominal pressure.

In the hypokinetic form of dyskinesia, LH is carried out lying on the back, on the left and right side, in emphasis on the knees, kneeling with hands on the floor, sitting and standing. Perform general developmental and breathing exercises with gradually increasing amplitude and pace of movements. The LH complex also includes exercises for the abdominal press, walking; "belly breathing" helps to reduce (or eliminate) pain. Duration of classes 20-30 min. In the period of complete remission, games, skiing, rowing, skating, cycling, swimming, etc. are recommended.

In the hyperkinetic form of dyskinesia, LH is performed lying on the back, right and left side. Includes general developmental, breathing and relaxation exercises. Exercises for the abdominal press, exercises with shells (dumbbells, stuffed balls), as well as tension and holding the breath are not recommended. The pace of the exercises is slow and medium. The duration of classes is 15-20 minutes. In the period of complete remission - dosed walking, skiing, swimming, occupational therapy, skating, etc.

Massage tasks: normalization of the psycho-emotional state and function of the biliary tract, analgesic effect, elimination of congestion in the gallbladder.

Massage technique. First, a massage of the collar region and back (segmental zones VIII-X of the thoracic and I-II lumbar vertebrae, especially on the right) is performed using segmental techniques. Massage is carried out in a sitting position. Then, in the supine position, the stomach and oblique muscles of the abdomen are massaged. The procedure is completed by squeezing the lower segments of the lungs (on the exhalation of the patient), Repeat 3-5 times, then ask the patient to "breathe in the stomach" for 1-2 minutes (while the legs are bent at the knee and hip joints). Techniques are excluded: chopping, tapping and deep kneading (especially in the area of ​​the right hypochondrium). The duration of the procedure is 8-12 minutes. Course 10-15 procedures.
^ Chronic cholecystitis
Chronic cholecystitis is a chronic inflammation of the gallbladder. May occur after acute cholecystitis, but more often develops independently and gradually. The occurrence of chronic cholecystitis is promoted by various bacterial flora. There are cholecystitis of toxic and allergic nature.

An important predisposing factor in the development of cholecystitis is stagnation of bile in the gallbladder, which can be caused by gallstones, compression and kinks of the bile ducts, dyskinesia of the gallbladder and biliary tract, arising under the influence of various emotional stresses, endocrine and autonomic disorders, etc. Stagnation of bile in the gallbladder rare meals, heavy physical exertion, hypothermia, etc. also contribute. Dull, aching pains in the right hypochondrium are characteristic. The pains radiate up to the area of ​​the right shoulder, neck and right shoulder blade. Dyspeptic phenomena are not uncommon: bitterness and a metallic taste in the mouth, nausea, flatulence, impaired defecation. Irritability and insomnia are also noted.

Palpation of the abdomen is determined by pain in the projection of the gallbladder on the anterior abdominal wall and slight muscular resistance of the abdominal wall. The liver may be somewhat enlarged, with a dense and painful edge on palpation (with the development of chronic hepatitis, cholangitis).

Along with complex treatment (diet, drug therapy, etc.), massage, LH (Fig. 85), swimming, skiing, etc. are prescribed.

Indications for massage: non-calculous diseases of the gallbladder, combined with a decrease in motor activity and tone of the gallbladder. Massage is carried out during the period of remission (outside the stage of exacerbation).

Massage tasks: improvement of biliary function, bile outflow; removal of spasm; increased tone of the gallbladder and sphincters.

Massage technique. The reflexogenic zones of the spine are affected on the left and the Boas zone projecting onto the area of ​​the end of the XI-XII ribs on the right and being organ-specific for the gallbladder. In this projection, a zone of hyperesthesia (increased tactile sensitivity) is revealed due to a pathological trophic viscerocutaneous reflex. Apply stroking, rubbing and kneading. When acting on the reflexogenic zone of the spine, segmental massage techniques (“saw”, “drilling”, “shifting”, etc.) are used in combination with stroking, rubbing. The duration of the massage is 10-15 minutes.

After the massage, the secretory and excretory function of such an important organ as the liver increases significantly (r constipation
Constipation can be of functional or organic origin. Functional disorders of the motor function of the intestine include spastic and atonic states.

Rice. 85. Approximate LH complex for cholecystitis
The pathogenesis of constipation is associated with reflex influences from the central nervous system or changes in the intramural innervation apparatus of the intestine, a decrease in the production of cholinergic and an increase in andrenergic substances, disturbances in electrolyte and mineral metabolism, which causes the development of intestinal dyskinesia and constipation.

Spastic and atonic colitis are revealed.

Showing massage, LH (Fig. 86), hydrocolonotherapy, swimming, rowing, etc.

Massage goals: in case of spastic colitis - to achieve an antispastic effect, normalization of reflex connections, blood circulation and intestinal motility; with atonic colitis - stimulation of the parasympathetic nervous system, increased blood and lymph circulation in the intestine, normalization of intestinal motility.

Massage technique. To stimulate the motor function of the large intestine with its lethargy, massage the lumbar region, sacrum, gluteal muscles, abdomen, groin, thigh muscles. Techniques are used: stroking, rubbing, kneading and, to a greater extent, vibration. With spastic colitis, vibration techniques are excluded. The duration of the massage is 5-10 minutes. 15-20 procedures per course. 2-3 courses per year.

Rice. 86. Approximate LH complex for colitis
When colitis is detected in women, gynecological massage is indicated. Duration 3-5 min. For a course of 5-8 procedures (performed in a day or two).
gastroptosis
Gastroptosis - prolapse of the stomach. Among the causes of this disease, there are such as weakening of the abdominal muscles, significant weight loss, asthenic condition, physical inactivity, etc. Patients with prolapse of the stomach are characterized by complaints of a feeling of heaviness, pressure and a feeling of fullness in the epigastric region after eating, belching with air, protrusion of the lower abdomen, flatulence, etc. Comprehensive treatment includes massage, LH, swimming, physiotherapy, diet therapy. LH (Fig. 87) is performed lying on your back (with a raised pelvis), on all fours, in the knee-elbow position. They include general developmental exercises, breathing (“diaphragmatic” breathing), exercises with a rubber shock absorber, dumbbells, hydrokinesitherapy is also shown (swimming with a board, in fins, with spatulas, playing in the pool), cryomassage of the abdomen. In the future, vibromassage of the back, gluteal muscles, lower extremities is used for 10-15 minutes. Course 15-20 procedures.

Rice. 87. Approximate LH complex in gastroptosis