Restoring sensitivity. Numbness of the skin after surgery, causes and consequences

So, experience is the goal of the described therapeutic model. At the same time, it can only be achieved in contact with certain properties. And such properties are sensitivity, awareness, free choice and presence. At the same time, these properties of contact are also, in relation to the practice of psychotherapy, necessary conditions for the restoration of experience and, therefore, the tasks of psychotherapy focused on experience.

Sensitivity is the source of all processes occurring in contact, and therefore in the field. If sensitivity is weakened or lost, then there is no need to be aware and worry at all. The field seems to freeze within the structure formed by the current self-paradigm. Therefore, the therapist’s task is to help restore field dynamics. Considering that sensitivity is a property of contact, the therapist, being its agent, can, through phenomenological manifestations of his presence, enable the client to be impressed by what is happening in the field. For example, this could be the therapist's response to the client's story or reactions to the latter's behavior in therapy. What the client simply did not notice a moment ago, now he has no opportunity to ignore. For example, the pain or fear felt by the therapist while the client was telling his life story can serve as such a source of restoration of sensitivity. BUT on one condition. Namely, these facts of the therapist’s consciousness must be placed in contact for the client, and the therapist must be present in them. Otherwise, they may remain “radio sound.” Most likely, the client will even do anything to avoid hearing the therapist and not being impressed by his words, since they necessarily contain a threat to the client to face what he refuses to experience.

I think I warned that we would move quickly on this topic. Let us assume that the therapist managed to increase the sensitivity of the therapeutic contact. This means that the question “Has anything changed in the field?” no longer worth it, since the answer to it appears quite quickly. But the next question appears - “What has changed?”, which refers us to another fundamental property of contact - awareness. I hope that theses about the belonging of sensitivity and awareness to the field no longer sound unusual to you.

How can a therapist increase the quality of awareness in contact? Since awareness is in a sense “one function for two” - remember the basic thesis of psychotherapeutic phenomenology of the described model “I am this way because you are” - until the nature of the field is restored in a single stream of experience, the source of awareness can only be a phenomenological stream in one of the sectors of the field, called “therapist”. Although, the client’s ability to understand what is happening in the field is almost never completely impaired. Strictly speaking, the sources of phenomenological activity in the field until the restoration of a single flow of experience are both sectors of the field - the therapist and the client. In other words, phenomena in therapy for the future process of experiencing are “mined” in the “mines of consciousness” of both the therapist and the client. Why do I always make this reservation - before the process of experiencing is restored? Because at this moment it becomes obvious that awareness belongs to the field. Until this time, the illusion of the structure of the field in the form of its segments “therapist” and “client” is much stronger.

We move on, despite the fact that we have only touched on this topic. If in the process of psychotherapy we managed to restore sensitivity and significantly expand the flow of awareness, then a new problem appears - choice. Just as in the case of loss of sensitivity a person simply does not need to be aware of anything, in the case of an insignificant volume of phenomena in the field there was no need to choose anything. And now human life has become much more complicated. This is not even a subject of debate - it has become more complicated by definition, since by implementing the previous task, we were able to significantly increase the number of phenomena that the client will now have to take into account in his life. But until now it was not necessary - therefore, before psychotherapy, life was simpler. It is for this reason that I often repeat that psychotherapy is the last place in line to turn to to simplify your life.

Most of the clients had no experience of free choice before coming to psychotherapy. We certainly made decisions in life, but we didn’t make choices. Therefore, one of the most important tasks facing the therapist is to create a culture of choice as opposed to a culture of decision. By the way, the same thing applies to the previous tasks of therapy - it is important for the therapist to form a culture in the therapeutic contact in which the source of awareness is not my personal consciousness, but the field. Then the process of awareness will turn from a volitional act of “extracting phenomena” into a spontaneous phenomenological process to which you simply need to surrender. The significance of the discovery of this difference for experiential-focused psychotherapy cannot be overstated.

But let's return to the task of restoring free choice. Let me remind you that choice, in contrast to decision-making, is an elementary mental act, which is the source of the vitality of the field. Within his nature all the foundations for him are already laid. It needs neither rational nor emotional justification. The therapist's task is to help the client gain experience of choice. Having felt this difference with making a decision, a person will never confuse them. Of course, as in previous cases with the restoration of sensitivity and awareness, a necessary condition for the formation of a culture of free choice is appropriate experience and appropriate freedom on the part of the therapist. After all, dialogue-phenomenological psychotherapy is, in a sense, therapy by the therapist himself. We will talk about particular aspects of the implementation of this and other tasks a little later.

Physical discomfort and various pain sensations are often perceived by many people so naturally that they do not pay due attention to the problem that has arisen. However, if your health worsens, then there are reasons for this, and they need to be dealt with. For example, when the fingers on the right hand go numb, this means that certain functions are impaired and need to be restored.

Why does finger numbness occur?

Initially, it is worth noting the following fact: numbness can be accompanied by several characteristic symptoms - tightness, chilliness, loss of sensitivity, burning and tingling. When the fingers of the right hand go numb and hurt, the cause is often considered neurovascular syndrome, which manifests itself against the background of high blood pressure and cervical osteochondrosis.

Sometimes loss of sensitivity is a consequence of an unhealthy lifestyle. But in any case, when the fingers on the right hand go numb, this is only a symptom indicating a specific dysfunction of the body.

If the problem with finger sensitivity does not go away, then you should not delay a visit to the doctor. However, there are cases in which urgent consultation with a doctor is necessary:

Rapid loss of sensitivity to water temperature;

Systematic numbness without obvious reasons;

Speech impairment;

Numbness of the hands, which interferes with proper coordination of movements;

Behavioral disorders, psychological or nervous disorders that appear simultaneously with loss of sensitivity;

Decreased sensitivity or tingling, accompanied by shortness of breath, rapid heartbeat, general weakness, nausea and dizziness.

When understanding why fingers go numb, you need to pay attention to the cause of this condition, Raynaud's syndrome. We are talking about a pathological condition that differs from the disease of the same name in that vascular spasms in the fingers are defined as a secondary symptom, indicating chronic diseases of the nervous system, endocrine disorders, intoxication, problems with connective tissue with constant exposure to cold and vibration. Raynaud's disease itself directly refers to numbness of the fingertips due to vascular spasms of small capillaries (most often occurs during hypothermia). Vasospasm can also be caused by severe stress.

Another answer to the question of why fingers go numb is a diagnosis such as arthrosis (arthritis) of the phalanges of the fingers, as well as the joints of the hand. The cause of loss of sensitivity can also be a violation of cerebral circulation. Numbness of the fingers in this case should be defined as the first symptoms of this pathology.

There are also more commonplace reasons for numbness in the fingers of the right hand. Since this hand is a working hand for many (seamstresses, those who have to write a lot, etc.), due to frequently repeated stress, the small muscles of the hand become overstrained and numbness occurs. To prevent this condition, there must be periodic pauses in operation. Competent finger motor skills will not be superfluous, exercises for which can be suggested by a qualified doctor. If you have to work outside at low temperatures, then it is imperative to protect your fingers from hypothermia (warm gloves). In other words, you need to take care of your finger joints and blood vessels.

Numbness symptoms

At first glance, it may seem that the symptoms of loss of sensitivity are obvious - tactile sensations are significantly reduced. But when complaining about numbness, ordinary people may mean various manifestations.

Therefore, it is worth clarifying exactly what symptoms should be attributed to this problem:

A condition in which the sensitivity of the skin decreases;

A tingling sensation that causes significant discomfort;

Feeling of so-called goosebumps moving;

In rare cases, a complex manifestation of all the symptoms mentioned above, or impaired joint mobility.

Causes of numbness in fingertips

Spring vitamin deficiency can often be cited as the cause of loss of sensitivity in the fingertips. If this is really the case, then you need to enrich your diet with foods that sufficiently contain vitamin groups A and B. You should not ignore these measures to restore the body, since a deficiency of vitamins can lead to significant complications. For example, there is a risk of developing atherosclerosis (blockage) of blood vessels in the fingers. Numbness in the fingers of the right hand can also develop for other reasons: endocrine diseases, consequences of injury and inflammation of the joints.

You should pay attention to various accessories that are attached to the hand or fingers. For example, bracelets, straps or rings that are too tight and do not fit the right size can put pressure on blood vessels and nerve endings.

The impact of poor lifestyle on the condition of fingers

Bad habits can cause numbness in the fingers of your right hand. The reasons why an incorrect lifestyle can cause such significant harm are quite simple:

- Alcohol abuse. With stable consumption, alcoholic beverages lead to disruption of the peripheral nerves of the upper and lower extremities. As a result, a sensation of “goosebumps” appears, after which the skin begins to lose sensitivity and the sense of touch is impaired. If alcohol continues to enter the body in significant quantities, coordination may deteriorate and difficulty performing hand movements. In this condition, it will be difficult to fix even a light object with your fingers.

- Excess weight. With developing obesity, the body's metabolism and blood flow, on which the full functioning of the legs and arms depends, are disrupted. As a result, the fingers and palms lose sensitivity and begin to go numb. If an overweight person suffers from physical inactivity (lack of physical activity and movement), then signs of loss of sensitivity appear especially clearly.

- Smoking. Both the tars contained in nicotine and nicotine itself have an extremely destructive effect on the walls of blood vessels. They (the vessels), in turn, begin to thin out, become non-plastic and brittle. This condition of damaged areas of the circulatory system leads to the fact that blood access to the upper extremities is difficult and numbness of the fingers of the right hand develops. The reasons for the development of atherosclerosis of the blood vessels of the hands largely go back to the process mentioned above. It is important to understand that sclerosis of the limbs is too serious a disease to be ignored. We are talking about consequences such as gangrene and even amputation of the hand.

As you can see, numbness in the fingers can be a symptom of extremely destructive processes in the body. Therefore, you should not delay diagnosis and, if necessary, qualified treatment.

Numbness of the right thumb

Speaking about problems with the thumb, it is worth remembering carpal tunnel syndrome. This pathology, depending on the degree of damage, affects the loss of sensitivity of the phalanx of the thumb, as well as the middle and index fingers. In this condition, compression occurs on the median nerve, which runs through the carpal tunnel.

The thumb can also become numb due to specific working conditions in which the hand is fixed in one position for a long time. As a result, stenotic ligamentosis of the transverse ligaments develops, against the background of which swelling of the connective tissue of the wrist progresses. Next, compression of the nervous tissue occurs, since the impulse passing through it becomes weak. The consequence of the weakened impulse is stiffness in the movement of the phalanx. For the same reasons, you may feel numbness in the ring finger of your right hand.

The thumb can also go numb due to the development of diseases such as neurofibroma and hemangioma. This diagnosis refers to tumors that can put pressure on nerve endings. A visit to the doctor should be planned if the loss of sensitivity lasts more than half an hour. If the treatment process is ignored, the progressive disease can lead to atrophy of the thumb muscles.

Why does my index finger go numb?

Loss of sensation in the area of ​​this finger also indicates the possible development of diseases such as arthrosis and arthritis of the elbow joint. The essence of the effect of arthrosis is the destruction of the joint tissue of the elbow, accompanied by pain. The nerves and vessels passing through the cubital canal are compressed, resulting in loss of tactility. Bringing the fingers together becomes extremely problematic for the patient.

The reasons for the development of arthritis can be identified as an infectious pathology that leads to an inflammatory process, or stable and significant loads on the elbow joint. As a result, the conductivity of nerve impulses noticeably decreases and the sensitivity of the index finger is lost.

Numbness of the middle finger of the right hand

When numbness is felt in the middle and index phalanx of the right hand, it makes sense to suspect structural abnormalities in the tissues. The consequence of such disorders can be functional disruptions in the functioning of the discs and muscles of the neck, as well as intervertebral tissues. The result of such changes is compression of the nerve endings, leading to signal blocking. In addition, there is a high probability of pain symptoms in the forearm and shoulder area.

Regarding the issue of loss of sensitivity of the middle phalanx, it should be noted that the cause of this condition is often neuropathy of the peripheral zone, which was obtained in the process of violating the integrity of the distal processes of the nerve receptors located in the radial nerve. Such disorders occur when a nerve fiber is damaged or ruptured. The cause of the rupture is usually carpal tunnel syndrome or subluxation, as well as a sprained elbow joint.

Why do my fingers go numb at night?

The cause of numbness during sleep is the uncomfortable position of the arm, in which the blood vessels are pressed under the influence of body weight, and the limb begins to go numb. This can be easily corrected by changing the posture and, as a result, removing the load from the arm.

Another reason why your fingers may go numb is uncomfortable clothing that pinches the blood vessels. That is why it is not recommended to use tight, uncomfortable underwear, including pajamas.

Gymnastics that restores sensitivity in the fingers

In order to neutralize numbness, it is necessary to perform the following exercises for the fingers, which can give good results:

In a lying position, you need to raise your hands up and clench and unclench your fingers 80 times.

For the next exercise, you need to stand facing the wall with your arms raised up, while leaning on your toes. You need to stand like this for about a minute, after which you should repeat the exercise several times.

The final element of the gymnastics looks like this: in a standing position (on a full foot), you need to clasp your hands behind your back and hold them like that for 1 minute. This exercise is repeated 3 times.

Charging for fingers with constant workload on the hands

Numbness in the fingers of the right hand can have different causes. One of them is the constant load on the hands. To neutralize the harmful effects of monotonous work, you need to perform the following exercises:

The palms are pressed against each other, while the fingers are crossed. They (fingers) need to be bent and straightened several times.

Clench and unclench your fists with your palms pressed together.

Leaving your thumb motionless, you need to touch it with the tips of your other fingers.

The fist is clenched (with force) for several seconds, after which the fingers are extended. Afterwards, you need to squeeze each of them in turn, with the tip of the phalanx reaching the middle of the palm.

The hand should be placed on the table so that the hand hangs over the edge of the tabletop. Next, you need to move your hand down and up, leaving your hand motionless.

Treatment of loss of sensation

Since, as mentioned above, numbness of the fingers is a symptom of the disease, treatment should be focused on neutralizing the original source of the problem.

Among others, we can highlight such popular techniques as magnetic-vacuum acupuncture, osteopathy, vibration finger massage and phonophoresis, which refers to the administration of medications using ultrasound.

The doctor approaches the treatment process individually, since the causes of loss of sensitivity may be different and may be accompanied by some complications. After diagnosis, treatment of numbness in the fingers of the right hand, as a rule, involves the use of one of the following therapeutic measures:

The use of anti-inflammatory drugs in case of detection of neuritis and osteochondrosis (Prednisolone, Hydrocortisone, Amidopyrine, etc.);

Introduction of an active lifestyle;

Prescribing a hand massage to improve lymphatic drainage and blood circulation (it is important to massage each finger separately from the tip to the wrist);

Taking vitamins A, B, E (Aneurin, Thiamine, etc.);

Controlling the amount of liquid and salt used in the diet (especially important for pregnant women);

The use of drugs that strengthen the walls of blood vessels, improve blood circulation and lower cholesterol levels (Venolek, Vasoket, Detralex, Venarus).

Considering the fact that numbness is, in fact, a manifestation of a specific disease, if you lose sensitivity in the fingers of your right hand, it is important to visit a doctor and get diagnosed. This will allow you to find out the real problem and act on it before complications arise.

Leptin, the satiety hormone, was discovered not so long ago. And perhaps not everyone knows that exceeding its level in a person’s blood is fraught with the development of many serious diseases: heart attacks, vascular complications, etc. Considerable hopes were pinned on the discovery of this hormone, but so far the scientific world has not been able to create a drug that can make leptin help people suffering from obesity. Therefore, today the activity of leptin can only be seriously affected by a radical revision of one’s own lifestyle and diet.

How to Restore Leptin Sensitivity: Important Steps

1. Your breakfast should contain food containing protein. And you need to eat such a breakfast no more than an hour after waking up. Subsequent meals do not require a large amount of protein, and if about 30 g of protein is enough for breakfast, then in just a day you need to eat about 100 g of food containing protein. This tactic will help reduce your food cravings for fructose and other sugars.
2. You should not include more than 30 g of fructose in your menu, since infatuation with this monosaccharide increases resistance to leptin, which leads, in particular, to damage to the main metabolic organ - the liver.
3. There is no need to completely give up carbohydrates: they are required for the coordinated functioning of all hormones, effective fat burning, electrolyte balance and a feeling of fullness after eating. It would only be correct to reduce their quantity to a minimum due to fast-acting carbohydrates (sweet fruits, flour, potatoes, rice). Another important point is to significantly limit the consumption of carbohydrates for breakfast.
4. Be sure to make sure that your diet contains foods containing zinc, since this microelement helps not only strengthen the immune system. Insufficient zinc in the body can lead to insulin resistance and the risk of diabetes.
5. Vitamin D and magnesium are required to restore sensitivity to leptin. This tandem can counteract obesity and complex changes associated with metabolic disorders. This couple is also able to counteract the occurrence of diabetes, osteoporosis, diseases provoked by our own immunity, as well as diseases of the reproductive system. In addition, a lack of magnesium in the body affects a significant deterioration in the quality of sleep. In turn, constant lack of sleep leads to a decrease in leptin levels and, on the contrary, increases the level of ghrelin, the appetite hormone.
6. Make it a rule to eat only the right fats - nuts, butter and coconut oil, avocado - and some animal fats (for example, goose).

1. Do not disrupt your body's natural circadian rhythms by overindulging in caffeine, sweets and alcohol.
2. Do not get carried away with snacks in cafes, fast food outlets, etc. Such food is fraught with disruption of the intestinal microflora and threatens chronic inflammation. And in principle, forget about snacks, you are drawn to them because your body is immune to leptin. Snacking disrupts the daily rhythm of leptin functioning. Imaginary ideas about their necessity to speed up the metabolic process or to maintain blood sugar at the proper level provide only new prospects for the development of obesity.
3. Don't eat at night. The evening meal and breakfast should be separated by at least half a day, because in the evening hours leptin “orchestrades” the adjustment of other hormones to the night recovery process and accelerated fat burning. Thus, by eating dinner later than 3 hours before bedtime, you interfere with the beneficial work of leptin.

Let us note that humanity has only recently come to understand the importance of restoring the body’s sensitivity to leptin, and this should be taken quite seriously.

The central nervous system (CNS) is a single mechanism that is responsible for the perception of the surrounding world and reflexes, as well as for controlling the system of internal organs and tissues. The last point is performed by the peripheral part of the central nervous system with the help of special cells called neurons. They make up the nervous tissue that serves to transmit impulses.

The processes coming from the body of the neuron are surrounded by a protective layer that nourishes the nerve fibers and accelerates impulse transmission, and this protection is called the myelin sheath. Any signal transmitted along nerve fibers resembles a current discharge, and it is their outer layer that prevents its strength from decreasing.

If the myelin sheath is damaged, then full perception in this part of the body is lost, but the cell can survive and the damage will heal over time. If the injuries are quite serious, you will need drugs designed to restore nerve fibers like Milgamma, Copaxone and others. Otherwise, the nerve will die over time and perception will decrease. Diseases that are characterized by this problem include radiculopathy, polyneuropathy, etc., but doctors consider multiple sclerosis (MS) to be the most dangerous pathological process. Despite the strange name, the disease has nothing to do with the direct definition of these words and, when translated, means “multiple scars.” They arise on the myelin sheath in the spinal cord and brain due to immune failure, which is why MS is classified as an autoimmune disease. Instead of nerve fibers, a scar consisting of connective tissue appears at the site of the lesion, through which the impulse can no longer pass correctly.

Is it possible to somehow restore damaged nerve tissue or will it forever remain in a crippled state is a relevant question to this day. Doctors still cannot answer this question accurately and have not yet come up with a full-fledged drug to restore sensitivity to nerve endings. Instead, there are various medications that can reduce the process of demyelination, improve nutrition of damaged areas and activate the regeneration of the myelin sheath.

Milgamma is a neuroprotector for restoring metabolism inside cells, which allows you to slow down the process of myelin destruction and begin its regeneration. The drug is based on vitamins from group B, namely:

• Thiamine (B1). It is essential for the absorption of sugar in the body and the production of energy. With acute thiamine deficiency, a person's sleep is disturbed and memory deteriorates. He becomes nervous and sometimes depressed, as in depression. In some cases, symptoms of paresthesia are observed (goosebumps, decreased sensitivity and tingling in the fingertips);
• Pyridoxine (B6). This vitamin plays an important role in the production of amino acids, as well as some hormones (dopamine, serotonin, etc.). Despite rare cases of a lack of pyridoxine in the body, due to its deficiency, a decrease in mental abilities and a weakening of the immune defense are possible;
• Cyanocobalomin (B12). It serves to improve the conductivity of nerve fibers, resulting in improved sensitivity, as well as to improve blood synthesis. With a lack of cyanocobalamine, a person develops hallucinations, dementia (dementia), disturbances in heart rhythm and paresthesia are observed.

Thanks to this composition, Milgama is able to stop the oxidation of cells by free radicals (reactive substances), which will affect the restoration of sensitivity of tissues and nerve endings. After a course of taking pills, there is a decrease in symptoms and an improvement in general condition, and the drug must be taken in 2 stages. In the first, you will need to make at least 10 injections, and then switch to tablets (Milgamma compositum) and take them 3 times a day for 1.5 months.

Staphaglabrine sulfate has been used for quite a long time to restore the sensitivity of tissues and the nerve fibers themselves. The plant from whose roots this drug is extracted grows only in subtropical and tropical climates, for example, in Japan, India and Burma, and it is called smooth stephania. There are known cases of obtaining Stafaglabrine sulfate in laboratory conditions. Perhaps this is due to the fact that stephania smooth can be grown as a suspension culture, that is, suspended in glass flasks with liquid. The drug itself is a sulfate salt, which has a high melting point (more than 240 ° C). It refers to the alkaloid (nitrogen-containing compound) stepharine, which is considered the basis for proaporphine.

Stephaglabrine sulfate serves to reduce the activity of enzymes from the class of hydrolases (cholinesterase) and to improve the tone of smooth muscles that are present in the walls of blood vessels, organs (hollow inside) and lymph nodes. It is also known that the drug is slightly toxic and can reduce blood pressure. In the old days, the medicine was used as an anticholinesterase agent, but then scientists came to the conclusion that Stephaglabrine sulfate is an inhibitor of connective tissue growth activity. From this it turns out that it delays its development and scars do not form on the nerve fibers. That is why the drug began to be actively used for injuries to the PNS.

During the research, specialists were able to see the growth of Schwann cells, which produce myelin in the peripheral nervous system. This phenomenon means that under the influence of the medication the patient noticeably improves the conduction of impulses along the axon, since the myelin sheath begins to form around it again. Since the results were obtained, the drug has become hope for many people diagnosed with incurable demyelinating pathologies.

It will not be possible to solve the problem of autoimmune pathology only by restoring nerve fibers. After all, no matter how many lesions have to be eliminated, the problem will return, since the immune system reacts to myelin as a foreign body and destroys it. Today it is impossible to eliminate such a pathological process, but you no longer have to wonder whether the nerve fibers are being restored or not. People are left to maintain their condition by suppressing the immune system and using drugs like Stefaglabrin sulfate to maintain their health.

The drug can only be used parenterally, that is, past the intestines, for example, by injection. The dosage should not exceed 7-8 ml of 0.25% solution per day for 2 injections. Judging by time, usually the myelin sheath and nerve endings are restored to some extent after 20 days, and then a break is needed and you can understand how long it will last by asking your doctor about it. The best result, according to doctors, can be achieved through low doses, since side effects develop much less frequently, and the effectiveness of treatment increases.

In laboratory conditions, during experiments on rats, it was found that with a concentration of the drug Stefaglabrin sulfate of 0.1-1 mg/kg, treatment proceeds faster than without it. The course of therapy ended earlier when compared with animals that did not take this medicine. After 2-3 months, the rodents’ nerve fibers were almost completely restored and the impulse was transmitted along the nerve without delay. In the experimental subjects who were treated without this medication, recovery lasted about six months and not all nerve endings returned to normal.

Copaxone

There is no cure for multiple sclerosis, but there are drugs that can reduce the effect of the immune system on the myelin sheath, and these include Copaxone. The essence of autoimmune diseases is that the immune system destroys the myelin located on nerve fibers. Because of this, the conductivity of impulses deteriorates, and Copaxone is able to change the target of the body’s defense system to itself. The nerve fibers remain untouched, but if the body’s cells have already begun to corrode the myelin sheath, then the drug will be able to push them aside. This phenomenon occurs because the drug is very similar in structure to myelin, so the immune system switches its attention to it.

The drug is able to not only take on the attack of the body’s defense system, but also produces special cells of the immune system to reduce the intensity of the disease, called Th2 lymphocytes. The mechanism of their influence and formation has not yet been thoroughly studied, but there are various theories. There is an opinion among experts that dendritic cells of the epidermis are involved in the synthesis of Th2 lymphocytes.

The produced suppressor (mutated) lymphocytes, entering the blood, quickly penetrate into the part of the nervous system where the source of inflammation is located. Here, Th2 lymphocytes, due to the influence of myelin, produce cytokines, that is, anti-inflammatory molecules. They begin to gradually relieve inflammation in this area of ​​the brain, thereby improving the sensitivity of nerve endings.

The drug has benefits not only for the treatment of the disease itself, but also for the nerve cells themselves, since Copaxone is a neuroprotector. The protective effect is manifested in stimulating the growth of brain cells and improving lipid metabolism. The myelin sheath mainly consists of lipids, and in many pathological processes associated with damage to nerve fibers, their oxidation occurs, so the myelin is damaged. The drug Copaxone can eliminate this problem, as it increases the body's natural antioxidant (uric acid). It is not known why the level of uric acid increases, but this fact has been proven in numerous experiments.

The drug serves to protect nerve cells and reduce the severity and frequency of exacerbations. It can be combined with medications Stefaglabrin sulfate and Milgamma.

The myelin sheath will begin to recover due to the increased growth of Schwann cells, and Milgamma will improve intracellular metabolism and enhance the effect of both drugs. Using them yourself or changing the dosage yourself is strictly prohibited.

Whether it is possible to restore nerve cells and how long it will take only a specialist can answer, based on the results of the examination. It is prohibited to take any medications on your own to improve tissue sensitivity, since most of them are hormonal and therefore difficult to tolerate by the body.

Spinal injuries are one of the most severe types of injuries. Recently, the prevalence and severity of spinal column injuries has been increasing, which is associated with an increase in the amount of transport, traffic speed, the spread of high-rise construction and other factors in the modern way and rhythm of life.

Patients with spinal injuries make up 18% of all patients in trauma hospitals. These are mostly young people (average age is 17-35 years). Therefore, the treatment of spinal injuries is not only a responsible medical and social problem, but also an economic one, because the risk of developing permanent disability after spinal injury is very high.

Causes of spinal injuries

Among the causes of damage to the spinal column and the spinal cord, which is located inside, include:

• Road traffic accidents. In such cases, a person can be injured both as a pedestrian and while inside a vehicle. Particular importance is given to whiplash injury, which occurs when the neck is sharply bent and then straightened with the same force, throwing the head back. Such circumstances arise when 2 vehicles collide, during sudden braking at high speed. It is to prevent this type of injury to the cervical spine that there are head restraints in cars.
• Falling from a height. Such incidents are almost always accompanied by spinal fractures and spinal cord damage. Particularly dangerous is the case when the victim lands on his feet - most of the spinal column is injured.
• Diver's injury. It develops when a person dives from a height into the water head down. In this case, the victim hits his head against obstacles in the pond and strong flexion or extension occurs in the cervical spine with subsequent traumatization.
• Also, the cause of damage to the spine and spinal cord can be knife, gunshot, or explosive injuries when the traumatic factor hits the spinal area.

Classification of spinal injuries

Trauma to the spine and spinal cord has a clear classification, on which treatment tactics and prognosis directly depend. All injuries can be divided into open (with violation of the integrity of the skin) and closed (without them).
Depending on the nature of damage to the anatomical structures of the spine, there are:

1. Injuries to the ligamentous apparatus of the spinal column (ruptures and sprains of ligamentous structures). Refers to mild degree.
2. Vertebral body fractures. This includes compression injury, when the vertebral body is compressed and a compression fracture occurs (people with osteoporosis are especially susceptible to this mechanism). Also, fractures of the vertebral bodies can be comminuted, marginal, vertical, horizontal and explosive.
3. Damage to the intervertebral discs (rupture of the fibrous ring with prolapse of the inner part of the disc, acute Schmorl's hernia).
4. Fractures of the processes (spinous, transverse, articular) and vertebral arches.
5. Dislocations and subluxations of the vertebrae, fracture-dislocations.
6. Traumatic spondylolisthesis.

All fractures are divided into 2 groups:

• with displacement, when the normal axis of the spine is disrupted and there is a high risk of spinal cord compression;
• without displacement.

It is also important to divide spinal injuries into stable and unstable. Stable fractures occur when only the anterior part of the spine (vertebral bodies) is damaged. Moreover, if at the time of the blow the spinal cord was not damaged due to displacement of the vertebra, then in the future this risk is minimal.

An unstable fracture occurs when both the anterior and posterior parts of the spine (arches and processes) are damaged simultaneously. Moreover, if compression of the spinal cord did not occur at the time of injury, then the high risk of this complication remains in the future, since any movement can lead to such consequences.

Types of spinal cord injuries:

• concussion (this is a reversible functional impairment);
• bruise or contusion (organic damage to nerve tissue);
• compression, which can be caused by vertebral fragments, damaged disc, hematoma, edema, etc.;
• partial and complete rupture is the most severe damage, the consequences of which depend on the level of violation.

Symptoms of spinal injuries

The clinical symptoms of spinal injury primarily depend on whether the spinal cord is damaged, as well as on the location of the injury, its type and mechanism.

Signs of stable injuries

Stable spinal column injuries include:

• soft tissue bruises;
• ligament damage;
• stable fractures of the vertebrae (body, spinous, transverse processes without displacement).

Characteristic clinical symptoms:

• diffuse pain at the site of injury;
• swelling, bruising, hematomas in the area of ​​injury;
• movements may be limited slightly or severely, depending on the degree of pain;
• when the spinous processes are fractured, local pain occurs, sometimes you can feel their pathological mobility;
• in some cases, signs of radiculitis appear;
• with fractures of the transverse processes there is pain in the paravertebral areas;
• There are no neurological symptoms, except in cases of secondary radiculitis.

Cervical spine injury

Damage to the upper segments of the cervical spinal cord is life-threatening. The function of the cardiovascular and respiratory centers suffers, and this can lead to immediate death. If there is an injury at the level of the 3-4 segment of the spinal cord, the patient experiences tetraplegia (paralysis of the arms and legs), all types of sensitivity below the site of injury are lost. The respiratory muscles and diaphragm also suffer, which can lead to respiratory arrest.

When the 4-5 segment of the spinal cord is compressed, tetraplegia occurs, but without respiratory disorders. If 5-8 segments of the spinal cord are damaged, paralysis of various arm muscles develops and lower paraparesis is observed; dysfunction of the pelvic organs may be present.

Damage to the thoracic and lumbar spine

Damage to the thoracic spinal cord due to spinal injuries is accompanied by weakness in the legs and disruption of the genital and pelvic organs. Paralysis of the muscles of the anterior abdominal wall may occur. Respiratory disturbances may occur due to paralysis of the intercostal muscles.

Damage at the lumbar level leads to paralysis of various muscle groups of the lower extremities (foot, leg or thigh). Sensitivity below the location of the injury also suffers, and the function of the pelvic organs and reproductive system is impaired.

Diagnosis of injuries to the spine and spinal cord consists of interviewing the patient, clarifying complaints, the mechanism of injury, examination data of the person, determining the presence of neurological symptoms of spinal cord injury, as well as data from additional examination methods (radiography, MRI, CT, myelography, etc.).

Natal injuries

Birth injuries are a whole group of mechanical damage to fetal tissue that occurs during childbirth. One of the most serious types of birth trauma is spinal injury. Recently, the number of such injuries has decreased significantly as the number of deliveries by caesarean section has increased.

Factors that can lead to birth injury to the spine:

• obstetric care during childbirth;
• application of obstetric forceps;
• breech and other types of pathological presentation of the fetus;
• postmaturity;
• large fruit;
• rapid or prolonged labor;
• deep prematurity;
• abnormalities of fetal development.

Most often, the cervical spine and the adjacent brachial plexus are affected. Symptoms depend on the level of damage. As a rule, such an injury is accompanied by pain (the child is restless, constantly changes his position, testing physiological reflexes is painful). Torticollis, shortened or elongated neck may be observed. If the upper cervical segments of the spinal cord are damaged, a picture of spinal shock, various respiratory disorders, the “frog” position, urinary retention or incontinence can be observed.

If the brachial plexus is damaged, the child may develop Cofferat syndrome (paresis of the phrenic nerve), Duchenne-Erb palsy, Dejerine-Klumpke palsy, Kehrer palsy. All these syndromes have their own distinctive features and consequences.

Damage to the thoracic region is manifested by respiratory disorders resulting from paresis of the intercostal muscles, as well as lower paraparesis of the legs of a spastic nature, “flat belly” syndrome.

Trauma to the lumbar and sacral regions in infants is accompanied by flaccid paraparesis of the legs and dysfunction of the pelvic organs.

Recovery from a spinal injury in a newborn is long. In some cases, due to the high plasticity and degree of regeneration in infants, it is possible to completely get rid of the symptoms and consequences of injury, but in some cases persistent disability develops throughout subsequent life.

First aid for spinal injury

It is necessary to note 2 main points of care for spinal injury:

• reliable and correct fixation of the injured area;
• If possible, administer anesthesia.

It is necessary to lay the victim on a hard surface with his back, and he is not allowed to sit down or stand up. Regardless of the damaged area, the cervical spine must be securely fixed. There are special collars for this. If you don’t have such a device at hand, you can roll up a thick roll of clothing and secure it around your neck.

Several people should carry the victim to keep the body at the same level and minimize movements in the spine. Such transportation will help avoid secondary spinal cord injury.

In this case, it is necessary to monitor the person’s pulse and breathing. In case of violations, resuscitation assistance must be provided according to the general rules. Under no circumstances leave the victim alone and do not move him from place to place unless absolutely necessary. It is imperative to call an ambulance.

Principles of treatment and rehabilitation after spinal injury

The consequences of spinal injuries directly depend on the timeliness and correctness of first aid, on the type and mechanism of injury, and on concomitant damage to the spinal cord.

Treatment can be conservative or surgical. For mild injuries, treatment is only conservative. Prescribe symptomatic medications (analgesics, hemostatic, restorative, anti-inflammatory), strict bed rest, massage, exercise therapy, and physiotherapy.

In more severe cases, conservative treatment can be supplemented by closed reposition (simultaneous reduction of dislocations, fractures, traction) followed by immobilization of damaged segments of the spine (collars for the cervical spine, corsets for the thoracic or lumbar spine).

Surgical treatment is used in cases of spinal cord injury or high risk due to spinal instability. Surgery may also be prescribed if conservative therapy is ineffective. After surgery, strict immobilization or traction is used.

Recovery from a spinal injury is a rather long and labor-intensive process. For injuries without compression of the spinal cord, exercise therapy is indicated from the first days of rehabilitation. They start with breathing exercises and gradually perform exercises for the limbs and spine. The classes must be supervised by a rehabilitation specialist. Massage and physiotherapy are also prescribed.

In case of spinal cord injuries, recovery is complemented by drug treatment, which is aimed at the regeneration of nervous tissue, electrical pulse therapy, and acupuncture.

Unfortunately, it is not always possible to restore functions lost due to spinal injury. But the desire to get better, as well as competent treatment and a rehabilitation program, sometimes work wonders.

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Hip replacement surgery: rehabilitation after replacement surgery at home, reviews of recovery

Rehabilitation in the period after hip replacement is needed to restore the activity of the joint, relieve pain, prevent complications, prepare the leg for stress and improve the general well-being of the patient.

A successful rehabilitation process after hip replacement is associated with many features. Restorative procedures begin the very next day after surgery to replace the prosthesis, and they can last from 2 to 3 weeks.

Sometimes, for example, if a person has a weak immune system, the recovery period begins during the preoperative period. This is necessary so that the hip joints can be maximally prepared for replacement of the prosthesis and avoid disability.

Restorative procedures are based on the following principles:

• the strictest consistency;
• continuity of course;
• systematic classes with a doctor and independently;
• individual approach.

Rehabilitation: what is it for?

Some recovery measures after endoprosthetics should be carried out at home, however, absolute self-medication can be hazardous to health.

After all, the psychological peculiarity of a person is such that unpleasant painful sensations (a natural phenomenon in the postoperative period) will push him to instinctively save his leg.

As is known, inadequate exercise leads to muscle wasting and incorrect tone redistribution. As a result, the likelihood of contractures increases, which can lead to deformation of the pelvic and hip bones, complications when walking, and compensatory scoliosis.

Restorative measures after hip replacement are carried out under the supervision of doctors in a special health resort. In such centers, doctors will monitor the load so that muscle and joint tissues are developed correctly, muscle tone is restored and pain goes away.

Initial preoperative recovery period

The zero rehabilitation phase consists of special exercises. They must be done before surgery at home or in the clinic. Such training helps:

1. improving blood circulation;
2. prevent stagnant formations;
3. activate tissue trophism;
4. improve the finishing of the cardiovascular and respiratory systems;
5. develop hip joints;
6. eliminate pain syndrome;
7. remove discomfort.

Pay attention! The basic principle of the zero stage of rehabilitation is that each exercise should be done slowly and carefully.

Using your lower leg (not your knees), you need to make 5 circular movements counterclockwise and clockwise.

You need to forcefully press the previously straightened limb into the floor. The tension must be maintained for at least 7 seconds. The exercise is repeated about 10 times.

Without removing the heel from the floor, you need to bring it with the knee bent to the thigh. Then the leg should be returned to a straight position by slowly moving the heel in the direction from the hip. The exercise is repeated 7 to 10 times.

The buttocks should be contracted and held tense for about 8 seconds. You must do at least 10 repetitions.

The straightened limbs are smoothly spread to the sides, without being torn off from the surface. The exercise is repeated 10 times.

The straightened leg should be raised above the floor level a few centimeters, after which it should be slowly placed on the surface. You need to repeat the exercise no more than 10 times.

To achieve greater effectiveness of rehabilitation together with exercise therapy, before the start of hip replacement surgery, it is advisable to carry out several procedures of electrical stimulation of the femoral and gluteal muscular system, and massage of the lower extremities.

1-4 and 4-8 days

On the first day after the operation, the patient should remain in bed, so he is transported using a gurney. On the second day, you can gradually load the new joint with your own body weight using a walker or crutches. Sometimes the doctor prescribes partial load.

The main tasks during the rehabilitation period are as follows:

• doing exercises;
• getting out of bed independently;
• walking with crutches or a walker;
• independent use of the toilet;
• The patient must sit down and get up from the chair himself.

To avoid the risk of complications in the first phase of recovery after surgery, it is not recommended to wear shoes without a spoon, cross your legs, squat and lie on the side on which the operation was performed. Also, do not take a hot bath before the patient plans to go to bed, raise the leg more than 90 degrees, and constantly keep a bolster under the knee joint.

In the first two days after hip joint replacement, the doctor prescribes magnetotherapy or UHF, in which a therapeutic effect of temperature and radiation is applied to the area where the suture was made.

Such procedures have an analgesic and anti-inflammatory effect. Moreover, they can be performed without removing the bandage in the ward. If there are any contraindications to such procedures, UV irradiation of the wound is performed during the dressing process.

For preventive purposes, to avoid congestion in the lungs and prevent the development of pneumonia, initial recovery includes breathing exercises and vibration massage of the chest.

Also, at the beginning of recovery, the patient undergoes massage, exercise therapy and does exercises for the joints. At the same time, he learns to do isometric exercises, which consist of tensing the muscles of the buttocks, lower legs and thighs.

Therapeutic gymnastics after endoprosthetics is done every day for 15 minutes (from 3 to 5 sessions). In this way, it is possible to enhance metabolic and trophic processes in the muscles and mobilize the central nervous system. This type of gymnastic exercise is effective in cases of bilateral damage to the hip joints.

After 4 days after hip replacement, you should begin to climb stairs, placing your hand on the railing, taking no more than one step at a time.

To shorten the recovery period after joint replacement, the doctor prescribes massage and a course of exercise therapy.

So, climbing the stairs should be done as follows:

1. place a healthy limb on the top step;
2. raise the leg with the prosthesis one step higher;
3. place the cane or crutch on the step below;
4. place the operated limb one step lower;
5. reposition a healthy limb.

Climbing the steps of a house during the postoperative period should always begin with the leg that is healthy, and you should go down leaning on the operated limb. The fourth or fifth day is often called the phase of “deceptive possibilities”, because weakness and acute pain disappear on the 5th day of rehabilitation. Consequently, a person wants to restore sensation in the leg after prosthetics.

Important! At this stage, you cannot ignore the recommendations and load the limb. Otherwise, everything may end in a dislocation of the hip joint.

2-8 weeks

Rehabilitation during the period after hip replacement at 2-3 weeks, when the sutures have already been removed, includes a painless massage of the joint, in which light massage movements are used. Patients are also prescribed a special therapeutic and physical training complex of exercises:

• for small joints of the legs;
• sitting down on the bed using your hands;
• for chest and diaphragmatic breathing.

Particular attention should be paid to laying and securing the legs with special bolsters after surgery to replace the prosthesis. Rollers are placed under the knee joint on the outside to prevent external rotation of the femur.

During this period, the load on the muscles should increase. The operated leg should be exercised to restore strength and restore motor balance. After which the patient will be able to switch from crutches to a cane.

Recovery for 4-6 weeks in a sanatorium or at home must necessarily include a set of exercises aimed at developing the muscular system of the leg, in particular the hip joint.

The first recommended exercise is resistance (using an elastic band). You need to do it 2 times a day in 3 approaches. The ankle is wrapped with one end of the tape, the remaining part is attached to the leg of a chair or table.

The next exercise is resistance hip flexion. To do this, you need to lean against the wall on which the elastic band is attached and put your leg to the side. The limb should be understood forward and the knee should be straightened. Next you need to return to the starting position.

The third exercise is done in a standing position; it involves moving the limb to the side. You need to stand with the healthy side of your leg against the attached tape, and then move your prosthetic leg to the side and return to the starting position.

In the sanatorium, during the rehabilitation period after surgery to replace a prosthesis, it includes training on special simulators. And you need to walk using a cane until your balance is completely restored. You need to move every day for at least 10 minutes, three times a day, each time increasing the walking time, so that the artificial hip joint takes root normally.

After hip replacement, training should be easier. In order for the exercises to be beneficial and not harmful, you need to consult a trainer or watch a special video.

The best option after surgery would be to exercise on an exercise bike, which will help restore muscle tone and restore mobility of the hip joint.

Initially, the pedals can only be turned backwards, and then forwards. In this case, the knees should not be raised high. After a month, the load can be increased. Also, before starting classes, the machine needs to be adjusted to suit your height.

Late stage

The main rehabilitation after endoprosthetics surgery is to undergo a course of treatment in a sanatorium or health center, where there is special equipment.

The doctor selects the method of rehabilitation therapy individually, taking into account the stage and form of the disease of each patient. To return life to a healthy direction, the sanatorium uses various restorative procedures, for example, therapeutic massage.

The actions of a manual therapy specialist are aimed at restoring the muscular and ligamentous apparatus, relieving pain, activating blood circulation and eliminating pain.

Also, after an operation during which total endoprosthetics was performed, the doctor prescribes acupuncture to speed up the patient’s recovery. This procedure allows you to reduce pain by eliminating vascular spasm and improving the nutrition of tissue cells.

Physiotherapy is a procedure in which temperature, electric current, laser and ultrasound are applied to the recovery area. During mud therapy, metabolism is activated, resulting in improved tissue nutrition due to the healing properties of mud.

Hydrotherapy is also very helpful in the post-operative period. To quickly return to your normal life, you need to do water aerobics, take pine and salt baths and not forget about the Charcot shower.

Total hip replacement is a rather difficult operation, since the main category of patients who need it are elderly people. Therefore, it is necessary to replace a weak load with a heavier one no earlier than after 2-3 months. If such recommendations are not followed, then complications may arise.

• therapeutic exercises;
• special food;
• massage;
• drug therapy.

And don’t forget that you need to sleep and rest more.

A compression fracture of the spine, the consequences of which we will consider, is one of the most serious and dangerous forms of spinal injury. With such an injury, “compression” of the vertebrae occurs (one or several at once), which leads to a decrease in the height of the spinal column, which is why the consequences can be extremely severe.

If the vertebral body itself is “pressed” into the spinal canal, then destruction of the intervertebral disc and compression of the spinal cord is very likely, which is the cause of the development of paresis and paralysis of the limbs.

The most dangerous in this regard is considered to be a fracture of the cervical vertebrae, the consequences of which can be the most serious, including death. So, in the summer, the most common option is a fracture of the 4th, 5th or 6th cervical vertebra, the consequences of which we will describe below.

We call this type of injury a “diver’s injury,” since it is often suffered by those who like to dive from heights. It is usually caused by hitting the head on the bottom, often resulting in instant death.

By the way, abroad this injury is often called the “Russian injury”, since only our compatriots tend to “take it to the chest” and then dive from a decent height in an unknown place.

About compression fractures in general

In general, this is a fairly common injury that occurs when there is a sharp simultaneous compression and flexion of the spine. This specific load leads to a sharp increase in pressure on the discs and vertebral bodies, as a result of which the anterior part of the vertebra “flattens” and takes on a wedge shape. The result is a decrease in the height of the spinal column, which can cause part of the vertebral body to begin to press on the spinal cord.

The most common compression fractures are the first and second lumbar vertebrae, as well as the 11th and 12th thoracic vertebrae. In this case, either one of these vertebrae or several at once can be damaged. Very often, the cause of such injury is car accidents or falls from a height.

Separately, we can mention the prevalence of this type of injury in older people, which most often occurs as a result of the development of osteoporosis, in which bones weaken and become brittle. In this situation, a compression fracture can act as a complication of the underlying disease, although its danger does not decrease at all.

In general, spinal fractures in which there is no spinal cord damage are divided into 3 degrees. In the first degree, the height of the vertebra decreases by less than half, in the second - by about half. With the third degree, the decrease is the most significant - more than 50%. At the moment of receiving a fracture, the patient feels quite severe pain.

It is noteworthy that in cases where a fracture occurs in vertebrae weakened by other diseases with relatively minor injuries, the pain is insignificant and is often simply ignored.

In addition, it should be taken into account that the characteristic manifestation of damage to the nervous structures during a fracture is not the pain itself, but the appearance of neurological symptoms. For example, it could be numbness in the legs or arms, or simply muscle weakness.

About the consequences of compression fractures

As we have already said, a compression fracture itself can be very dangerous. Thus, one of the most dangerous is a fracture of the fifth cervical vertebra. The problem is that the cervical spine contains many blood vessels and nerve canals, so injury to this section often leads to very serious consequences.

Thus, unlucky “divers” at a minimum risk “earning” pathological segmental instability, which occurs due to a significant decrease in the height of the injured vertebra. There is no point in describing what will happen in the worst case, but the best scenario in this situation is quite dangerous.

Fractures in the thoracic region are very rare, since they are almost always the result of direct trauma. For example, a fracture of the 7th thoracic vertebra usually manifests itself as quite severe but tolerable pain (if there has been no spinal cord injury). As a result, a person often decides to “be patient, it will go away on its own.” Of course, it doesn’t go away on its own, but it adds a number of complications that are more difficult to cure.

Fractures in the lumbar region are quite complex, since it is this section that bears the maximum load.

A fracture of the 12th thoracic vertebra, or 1-2 lumbar vertebrae (fractures of the 3rd and 4th lumbar vertebrae practically do not occur) are not too dangerous if treatment was started on time and the spinal cord was not injured.

But a decrease in the size of one of the vertebrae in a given part of the spine almost always leads to rapid degenerative changes and injury to nerve endings, which results in chronic pain syndromes.

About the treatment of spinal fractures

Compression fractures of the vertebral bodies are an extremely unpleasant phenomenon, but they do not always require surgical intervention. Usually, the matter is limited to strict and prolonged bed rest, which can last several weeks, as well as taking analgesics that help get rid of pain.

Over time, of course, the vertebra will “grow together,” but the patient still has to deal with the consequences of the fracture. First of all, because the shape of the vertebra has changed and now it can shift under heavy loads. Moreover, sometimes a slight displacement can be observed immediately after the removal of the cast and the first attempts to move. This happens because the back muscles have seriously weakened during treatment and are not yet able to support the spine.

It should be understood that if a spinal fracture occurs, then treatment is not only a long stay without movement, but also hard work to rehabilitate the body.

Thus, the basis of the rehabilitation period is usually physical therapy and massage, which allow you to restore the condition of the back muscle corset. Physiotherapeutic procedures will also be useful to help restore normal metabolism in the area of ​​injury, and this is a good prevention of the possible development of degenerative processes.

• Back pain radiates to the leg, what is the reason?
• How to correct scoliosis at home?
• Why does the middle of the chest hurt after sleep?
• Causes and treatment of rotational subluxation of the C1 cervical vertebra
• The use of reflexology in the treatment of osteochondrosis

• Arthrosis and periarthrosis
• Video
• Hernia of the spine
• Dorsopathy
• Other diseases
• Spinal cord diseases
• Joint diseases
• Kyphosis
• Myositis
• Neuralgia
• Spinal tumors
• Osteoarthritis
• Osteoporosis
• Osteochondrosis
• Protrusion
• Radiculitis
• Syndromes
• Scoliosis
• Spondylosis
• Spondylolisthesis
• Products for the spine
• Spinal injuries
• Back exercises
• This is interesting

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