Rehabilitation after a spinal fracture

In the case of a spinal fracture, the treatment and rehabilitation of a person includes actions aimed at mitigating the severity of restrictive and disadvantaged conditions, allowing social integration to be achieved (WHO definition from 1981).

Rehabilitation is a process that goes beyond the healthcare system, its ultimate goal is to involve a person in an active life.

Development of a comprehensive rehabilitation plan

As part of comprehensive rehabilitation, the physiotherapist draws up a short-term and long-term plan according to the degree of damage to the patient's spine.

• Short term plan. It is set for a fixed period of several days, weeks, maximum 3 months, consists of an early and outpatient phase of rehabilitation. The physiotherapist offers specific treatments.  
• Long term plan. Compiled by a team of specialists, including a rehabilitation therapist, physiotherapist, occupational therapist, psychologist and, if necessary, a speech therapist or special education teacher. Based on objective testing, the prognosis is determined and a long-term plan for optimal resocialization of the patient is drawn up. The plan may also include a proposal for the patient to stay in a sanatorium or rehabilitation center.

Therapeutic rehabilitation

Therapeutic rehabilitation is a complex of restorative, diagnostic and therapeutic procedures. Their goal is to achieve a quick and maximum recovery of spinal function. Emphasis is placed on timely assistance, which significantly affects the overall reduction in complex rehabilitation, helping to prevent the occurrence of possible secondary complications. An integral part of therapeutic rehabilitation after a spinal fracture is the active cooperation of the patient.

Kinesitherapy (physiotherapy)

Exercise therapy is the main method of therapeutic rehabilitation, where for a therapeutic effect, to achieve the optimal function of the body as a whole, movement is specifically and purposefully used as the main manifestation of life. By doing exercises, the level of physical condition necessary for daily life is reached.

After a comprehensive analysis, the therapist sets out a detailed treatment plan and the goal that he wants to achieve with the help of kinesitherapy. Exercise therapy contains a wide range of procedures that can be changed during the course of treatment in accordance with the progress of the patient.

Exercise therapy should always be individually adapted to the current condition of the patient.

Exercise therapy as part of conservative therapy

Patients are prohibited from lifting objects from a slope, carrying heavy loads, making sudden movements, jumping, falling. The therapist trains the person as part of daily physical activity.

Exercise therapy during immobilization:

• static and dynamic breathing exercises involving peripheral joints;
• active exercises, isometric strengthening of the trunk muscles, exercises with auxiliary objects;
• exercises to stabilize the pelvis and hips;
• verticalization with an orthosis;
• holding the body with an orthosis.

Exercise therapy after immobilization:

• training getting up from a lying position to a standing position, skipping a sitting position;
• gradual restoration of the functions of the thoracic and lumbar spine;
• strengthening and gradual loading of the muscles of the body;
• breathing exercises (mainly abdominal type);
• exercises to relax the cervical spine;
• exercises to strengthen the muscles of the neck;
• correct sitting training
• active exercises;
• resistance exercises;
• mimic muscle training.

Exercise therapy as part of surgical therapy

After spinal fracture surgery, rehabilitation begins approximately 48 hours later. Banding is required for at least 6 weeks after surgery to prevent thromboembolic disease. For the period of bone healing (3-6 months), a mode of movement is necessary in accordance with the condition and capabilities of the patient.

During immobilization:

• verticalization with an orthosis;
• positioning;
• respiratory physiotherapy, respiratory hygiene;
• in accordance with the neurological lesion - exercise therapy on the bed, targeting the affected segment, restoring muscle balance;
• the practice of holding the body correctly;
• strengthening the muscular corset;
• neck muscle isometry.

After immobilization:

• gradual training of non-strengthened sections of the spine (movements in the fortified sections are not carried out);
• strengthening the muscular corset;
• body holding;
• scar care, soft and mobilization methods;
• occupational therapy;
• social rehabilitation;
• physiotherapy.

Vojta method - the principle of reflex locomotion

The principle of the Vojta method is the presence of genetically encoded basic movement patterns present in the CNS of each person.

The purpose of the method in recovery after a fracture of the spine is the reflex induction of physiological patterns of movements that are absent during spontaneous movements, or the restoration of motor mechanisms blocked in the brain as a result of an injury.

reflex crawl

Reflex crawling is a motor process that contains the most important components of moving forward:

• position control;
• lifting against gravity;
• purposeful step-by-step movements of the upper extremities.

Reflexive crawling contains the basic patterns of human forward movement. Starting position - on the stomach, head on the substrate, turned to the side.

The movement takes place mainly along the so-called. crossed scheme, in which the right lower and left upper limbs move simultaneously. Opposite lower and upper limbs support the body, carry the torso forward.

The therapist uses adequate resistance against the resulting turning of the patient's head. As a result, the work of all muscles is activated, conditions are created for verticalization.  

Reflex rotation

Reflexive rotation begins with a change from the position on the back to the position on the side, and ends with walking on all fours. Reflex rotation is applied in several phases in the position on the back and on the side:

• 1st phase. Begins in a supine position, upper and lower limbs are straightened. By activating the chest area in the intercostal space (7-8th rib) under the nipple on the line of the mammary glands, the therapist turns the patient into a lateral position, creating resistance to turning the head.
• 2nd phase. Reflex rotation begins in the lateral position. The upper and lower limbs support the body from below. They move it up and forward against gravity. In this case, the activation of the muscles of the lower upper limb occurs from the shoulder to the elbow, and then to the arm, which creates the supporting force of the palm. The whole turning process ends with walking on all fours.

R. Brankow method

This is a rehabilitation method for a spinal fracture, in which, without external stimulation of proprioreceptors and exteroreceptors, diagonal muscle chains are activated. This is achieved by the patient adopting positions based on psychomotor development.

Initial position:

• Stand next to a chair (the chair is on your right).
• Place the knee of the right leg on the floor, the left leg rests on the floor of the feet.
• Place your right hand on a chair, your left hand on your thigh.

Phase 1:

• Straighten your back.
• Slowly raise your right knee.

Phase 2:

• Keep going up until you are completely up.
• Repeat the exercise, switching sides (the chair is on your left).

Brugger's concept

The principle of the method is a change in the physiological course of movements and body holding due to pathologically altered afferentation.

According to the concept, at the beginning of each therapy, posture correction is performed based on 3 main movements:

• pelvic tilts forward;
• lifting the chest;
• neck stretch.

The training is followed by preparatory measures, including the positioning and application of thermal applicators to specific areas of the body, as well as passive therapeutic procedures. In conclusion, active therapeutic procedures are carried out.

Preparation for rehabilitation after a spinal fracture using the Brugger method:

• Heat water in a kettle.
• Prepare a towel (approximately 100x40 cm or 70x30 cm).
• Fold the towel in half lengthwise.
• Lay it on the floor, on the bed, etc.
• Put one of your knees on it.
• Start gradually rolling the tightened towel fabric into a roll.
• Hold the towel roll in your hand.
• Gradually pour the hot water from the kettle into the groove created by winding up the towel until it is 1/3 wet (hold the dry end of the towel).

Application procedure:

• Gradually unwind the soaked and heated cloth, place it on the affected areas.
• Let the fabric cool a little beforehand so as not to burn yourself.

Physical therapy

The possibilities of using physiotherapy after traumatic spinal injury include hydrotherapy, phototherapy and electrotherapy.

The use of electric currents or pulses is contraindicated in the presence of metal objects in the current path, with the exception of the use of pulsed low-frequency magnetotherapy. But the therapist can use various types of currents to influence other parts of the body, while observing the indicated contraindications.

Hydrotherapy

This set of procedures includes underwater massage, whirlpool baths, exercise therapy in the pool.

Underwater massage:

• the procedure can be performed in whole or in part;
• massage can be carried out in a special large bath;
• the water is isothermal, the pressure at the mouth of the nozzle is 200-400 kPa, the distance from the end of the hose to the surface of the body is 10-15 cm;
• the pressure of the water jet causes local anemia, which is subsequently replaced by local hyperemia.

Whirlpool bath:

• special baths for partial or full immersion are used;
• for a shared bath, slightly thermopositive water is used;
• a combination of a thermal effect and a strong mechanical effect of vortex water is used, which accelerates the contraction of scars, improves the outflow of lymph into the subcutaneous tissue.

Water exercises after a fracture of the spine in the pool:

• water temperature in the pool - 34-36 ° C;
• exercise uses natural water resistance and hydrostatic buoyancy pressure;
• the result is a positive psychological effect that encourages the patient to exercise without pain and tension;
• you can use auxiliary means (various forms of weighting, means to increase resistance).

Phototherapy

Phototherapy (light therapy) uses the photochemical and biostimulating effects of photon energy through the use of electromagnetic radiation in the visible light spectrum, infrared and ultraviolet radiation.

In rehabilitation after a spinal fracture, phototherapy uses mainly polarized laser light and biolamps. The main goal of the method is to support the healing of the skin and superficial structures. Therapeutic sun exposure (heliotherapy), which is usually part of a spa treatment, is also used.

Electrotherapy

Electrotherapy is one of the most researched therapies in the world. This non-invasive technique has been successfully used in simulation exercises, providing the possibility of passive training (while limiting the patient's mobility).

Results

Physical exercises performed as part of rehabilitation after a spinal fracture require the correct involvement of muscles in certain muscle chains that follow each other. This results in increased muscle activity throughout the body.

An important point is the timely start of rehabilitation, its adaptation to an individual diagnosis. Equally important is the accuracy of the exercises.

Since the therapeutic effect depends on the intensity and frequency of training, it is necessary to involve family members who play a primary role in achieving a positive result of therapy.