General physiotherapy.

Physiotherapy (physis - nature) is a science about using of external environmental factors with therapeutical

aim. These factors may be natural or modified.

Physical factor may have its first action in the organism on the level of afferent nerves or at the level of

sensitive molecular groups. The reactions to factors include local physico-chemical changes in the tissues & general

reactions: reflex or humoral.

So, there are two types of reactions: specific and nonspecific.

All physical factors have nonspecific action. It means the all factors may regulate two main physiological

functions of organism, & may be as adaptogenes, which help the organism to fight against different unfavorable

factors.

Specific action of factors depends on their nature & differs this factor from other.

Both actions influence on organism together, but the main action is a specific component. Using the dose of

physical factor we try to maximize specific action and minimize nonspecific. Counterreactions for physical factors are

individual. They are divided into physiological, pathological reactions (general, local) and increasing of the

pathological process activity.

That is why the physiotherapeutical procedures must be prescribed individually according to the etiology &

pathogenesis of the disease.

Physiotherapeutic prescription includes the individual plan of treatment.

Structure of physiotherapeutic prescription:

1) The name of physical factor;

1) The region of action;

1) The method of treatment;

1) Dose of physical factor (intensity of action);

1) Duration of procedure;

1) The frequency of actions;

1) The number of procedures for whole course of treatment.

Classification of physical factors (by professor A.N.Obrosov):

I. Electrical agents:

1) Direct current of low voltage (galvanization, electrophoresis)

1) Pulse current with

a) Constant direction & low frequency of impulses: electrostimulation, electrodiagnostic method,

diadynamotherapy;

a) Alternating direction and moderate frequency of impulses: interferential current, sinusoidal

modulated current (SMT);

3) Alternating current & alternating electromagnetic fields of high voltage:

a) Of high frequency: darsonvalization, ultratonotherapy, inductotherapy;

a) Electromagnetic field of ultrahigh frequency: UHF-therapy;

a) Electromagnetic field of super high frequency: microwave therapy

4) Direct electrical current of high voltage (franklinization);

II. Magnetic fields:

a) Of constant direction

a) Of alternating direction & low frequency

III. Electromagnetic radiation:

a) Infrared radiation

a) Visible radiation

a) Ultraviolet

a) Lasers

IV. Hydrotherapy:

a) Fresh water

a) Mineral & medical waters

a) Gaseous waters;

V. Thermotherapy:

a) Medical mud

a) Paraffin

a) Ozokerite

a) Naphthalane

VI. Mechanical energy:

a) Vibration

a) Ultrasound

VII. Artificial air environment:

a) Aeroions & hydroaeroions

a) Aerosols & electroaerosols

a) Barotherapy (changeable air pressure)

General contraindications for the use of physical agents:

Malignancy & suspicion for malignancy, including haemoblastosis;

Hormonoactive tumors of women in growthstage or tumors, required surgery (mastopathy,

endometriosis, uterine myoma);

Cachexia;

Febrilis temperature of the body;

Pulmonary tuberculosis, if the stabilization of the process is not achieved;

Systemic lupus erythematosus;

Acute phase of myocardial infarction;

Acute phase of stroke;

Prominent atherosclerosis (of heart & brain vessels);

Aneurysm of aorta & other large vessels;

Severe arterial hypertension with systolic pressure more than 180 mm Hg;

Complex & severe arrhythmias and disorders of myocardial conductivity;

Epilepsy with frequent seizures;

Severe deficiency of organs (heart failure II-III stages, chronic renal failure);

Presence of large metal chips near the large vessels and nerves in zone of physiotherapeutic action;

Individual intolerance to this type of energy;

Long professional contact with this type of energy.

Electrotherapy.

Electrical current is the flow of charged particles, such as electrons (in metals) or ions (in electrolytes). In

solutions & in the human body, an electrical current stimulates the movement or flow of ions.

Any substance can be considered to be electrically conductive if it allows the passage of charged particles.

Resistance is the opposition to the flow of charged particles, & is affected by the nature & structure of the material.

Conductance is the ability to transmit charged particles & is the reciprocal of resistance. The liquor and the blood

plasma have a high conductance; the less conductive tissues of body are whole blood, muscles, parenchimatosis organs.

The bones, fat, fascias, tendons & other connective tissue elements cannot transmit charged particles. Dry skin, hair can

be considered to be dielectrics.

Galvanization.

The main physical agent is direct current of low voltage (60-80 V) & low strength (< 50 mA). Apparatus:

AGN (wall galvanization apparatus)

AGP (portable galvanization apparatus)

AGS (stomatological galvanization apparatus)

GR (galvanization of oral cavity)

"Potok"

The main biophysical processes.

Galvanic current goes into the tissues throw the ostia of the oil and perspiratory glands, hair follicles,

intercellular spaces. Also the passage of charged particles in the tissues may be through the skin, if the agent has

prolonged action. Sometimes it is necessary to pass current throw the mucous membranes or wounds.

Later electrical current goes, generally, through the blood or lymphatic vessels in different tissues.

Scheme of ion's movement during galvanization: 1- electrodes; 2 -linings

Polarization is the process of ion concentration near electrodes according their charge. The positive ions

move toward the cathode (negative), where they pick up electrons, & the negative ions move toward the anode

(positive), when they give up electrons. "Current flow is considered to be from the anode to the cathode, that is,

opposite to the direction of electron flow.

After this process of electrolysis on the electrodes there is a great amount of acid & alkaline, that is why this

method needs cloth padding between electrodes & skin.

In the body ions are concentrated near cell membranes, because of their increased resistance. The ions are

concentrated near membranes so generating polarization zones and field inside tissues. The polarization potential

reaches to maximum (200-500 mV) in 25-30 min after action beginning. It is diminished after turning off an electrical

current.

Diffusion is the ion movement from the place of their large concentration to the small concentration. Osmosis

- is a movement of water from the place of small ion's concentration to the place of their large concentration. So,

physiological diffusion and osmosis in human tissues are intensified due to electrical current.

The main physiological reactions and their medical effects.

The physiological reactions due to direct electrical current are based on the ion excitation theory. According

to this theory for excitation the quantitive correlation between ions K+ and Na+ and Ca2+ and Mg2+ is very important.

Mobility of ions mainly depends on their hydrate cover size, i.e. connected dipole-molecules of water. Bivalent ions

with a great hydrate cover move slower than monovalent ions. As all enumerated ions have a positive charge they move

from the anode to the cathode. In a certain time the relative prevalence of more mobile ions K+ and Na+ will be under

the cathode. The concentration of less mobile ions Mg and Ca will be higher inversely under the anode.

The concentration of an enumerated ions and their concentration have a great significance for excitative

processes. The electrotonus is an excitability change in the electrical current at the moment of electrical chain backing

up the membrane penetrance of tissue is increased, and their electrical resistance is decreased under the cathode.

This change of excitability under the cathode is called catelectrotonus. The anelectrotonus is a decreasing of

membrane under the anode and increasing of membrane resistance. These particularities o excitability changes under

the cathode and anode are used in a direct electrical current application. The anode is an active electrode to decrease the

excitability of tissue. To increase the excitability of tissue it is necessary to use cathode.

The direct electrical current is transferred to the tissue by means of electrode, applicated on the skin. The

great part of voltage appears in the skin due to high skin resistance. On this skin region the patient feels slight burning,

creeping sensation, which are connected with irritation of sensitive nervous fibers. Edema and skin hyperemia are

observed under the electrodes. These changes are not connected with thermal effect of electrical current. Because of an

electrical current, used in galvanization, has so insignifical strength, so the mechanism of hyperemia is neuroreflective.

Due to local reflective-segmentative reactions the vessels are dilated. Through the appropriate skin regions it is possible

to influence on internal organs. The changes in the organs will be the same - increasing membrane penetrance,

intensification of diffusion & osmosis. The direct electrical current may be used to influence on central nervous system.

In the brain & spinal cord the high-laid centers have positive charge and the low-laid - negative charge. This condition

is called physiological anelectrotonus, it is necessary for normal activity of nervous system. It may be increased by

means of direct electrical current. The positive electrode is located in the forehead zone, and the negative electrode - in

the interscapularis region. This action improves coordinative and regulative functions of brain, which is useful at

cortico-visceralis diseases.

As a result of direct electrical current influence the stimulation of phagocyting macrophages system is

observed, which increases an effectivity of protective reactions.

The main indications for this method:

1) Inflammatory processes (without purulence) in the stage of resolution

1) Diseases & traumas of peripheral nervous system

1) Degenerative-dysthrophic diseases of the musculo-sceletal system

1) Dyskinesias of internal organs

1) Functional disorders of central nervous system.

The main contraindications for this method:

1) Acute stages of inflammation, purulence;

1) Injured skin (abrasions, scratches);

1) Acute & subacute eczema, other dermatitis in the region of electrodes application;

1) Presence of skin irritative symptoms after procedure;

1) Acutest pain syndrome because of trauma of peripheral nervous fibers.

Dosage depends on:

1) Density of electrical current (0,01-0,1 mA for 1 cm2 of electrode cloth padding)

1) Patient's sensation (slight tingling, burning sensation)

1) Duration of procedure (from 15 to 30 minutes)

1) Frequency of procedures (every day or every other day)

1) Duration of treatment course (10-15 procedures, possibly to 30).

Drug electrophoresis (iontophoresis).

Electrophoresis of medicines (iontophoresis) is the transcutaneous delivery of ions into the body to

therapeutic purposes using an electrical current. Iontophoresis is an alternative to oral or parenteral (e.g, needle

injection) methods of drug delivery. This method is called electropharmacological because of combination of

medication's & electrical current's effects.

But medication & galvanic current's effects is not simply summarized in this method. This factors together

increase effects of each other. Responsive reaction firstly depends on pharmacological characteristics of drug.

The rate of transcutaneous drug movement in electrical field of direct current is near 1 cm/hour. So, during

the procedure drug goes not so deeply & is concentrated in skin, & partly in subcutaneous fat.

This method has a number of specialities & advantages in comparison to other methods of drugs delivery:

1) Gives a possibility to make a superficial pathological region a high concentration of drug, to make a

local effect;

1) Drugs delivered by iontophoresis give adverse reactions rarely in comparison to drugs delivered orally &

parenterally;

1) This method is not painful, doesn't give skin deformation, disturbances of the microcirculation; the

irritation of mucous tissue of gastro-intestinal tract is absent;

1) The ions of drug delivered by iontophoresis show their maximal activity;

1) Drugs act in the tissues, changed by galvanic current; in these conditions their effect is more significant

even in small concentration.

Some drugs are electrically neutral, so they lose their activity in electrical field. To choose the needed drug

for electrophoresis the doctor should use special list of medications permitted for this method. This list includes

information about recommended concentrations of drugs, active ion, and polarity of the delivery electrode. The

substances which have complex & different ion composition are delivered from both electrodes.

The medications not dissolved in the water or in the spirits are delivered with dimethylsulfoxide (DMSO).

DMSO is the universal dissolver. For the ferment electrophoresis (lidasa, tripsin) buffers are used.

Nowadays the small concentration of medications (up to 5%) is used. The study about ionic reflections,

developed by A.E.Scherbut, explains the mechanism of the electrophoresis action on the organs & systems. According

to this study, skin receptors are irritated by drug's ions & direct current. Locally the ions influence through the

vegetative nervous tracts on internal organs. That is why the electrodes should be laid on the skin regions connected by

vegetative innervation with internal organs.

Using electrophoresis it is possible to make a high concentration of drug directly in the place of damage, laid

superficially, not to saturate the whole body.

The method of drug elimination from blood using galvanic current is called "intratissue electrophoresis". It is

used in internal diseases. In the beginning the drug is delivered in blood circulation (usually intravenously). Then

galvanization of appropriate organ or tissue begins. The electrodes are placed transversely, so the pathological area is

located between the electrodes. During this procedure the elimination of drug from blood, flowed through the damaged

organ or tissue, takes place.

Indications depend on pharmacological characteristics of medication & indications to galvanization.

Contraindications are the same to galvanization. The additional contraindication for this method is an

idiocratic reaction to drug.

Dosage is carried out as at galvanization.

II. Medical application of direct pulse current

Under action of an electrical current the living tissues are stimulated. The main response to direct constant

electrical current - motor reaction, that is reduction of muscle.The muscle responds to each impulse by reduction. That

greatest number of impulses, to each of which a muscle reponds by reduction, N.E.Vvedensky has named as a measure

of lability. The skeletal muscle is capable to respond by separate reductions to impulse frequencies up to 100 per one

second. At higher frequency of influence its tetanic reduction occurs.

The pulse currents used in physiotherapy are distinguished by the form of pulses: rectangular, triangular,

exponential, half-sine (fig. 3), according to frequency of pulses, according to duration of each pulse in millisecond

(msec).

Fig. 3 Graphic image of direct pulse electrical currents: 1 - triangular form; 2 - rectangular form; 3 -

exponential form; 4 - half-sine form.

1. Electrodiagnostics and electrostimulation.

Electrodiagnostics is a research of stimulation of neuromuscular system by an irritation by an electrical

current. Electrostimulation is a method of influence by an electrical current on the neuromuscular system. At realization

of electrodiagnostics and electrostimulation the pulse electrical current of a low voltage (60 - 80 v) and small force (up

to 50 mA), pulses various in form and duration is used in constant direction. Devices: - UEM (universal electropulse of

mountains), now is not made;

"Neuropulse";

SLPM (sinusoidal low-frequency pulse modulated);

"Tonus";

"Amplipuls";

"Stimulus".

The basic biophysical processes are the same, as at galvanization. Because of fast increase of force of a

current processes of diffusion and osmosis have no time to compensate infringements of ionic concentration in tissues.

These infringements are more significant, than in case of influence of galvanic current of the same force. The basic

physiological reactions and medical effect: the expressed irritating action of a pulse electrical current is observed.

Responcse reaction to this irritation is reduction of a muscle fiber. At the moment of short circuit the reduction of a

muscle under the cathode comes at smaller force of a current, rather than under the anode. The healthy muscle gives

thus flash-like reductions.

Electrodiagnostics is used for definition of a degree of weight of a defeat neuro-muscular system. At easy

defeats the quantitative changes are observed first of all: the reference intensity of an electrical current inducing a

muscle to reduction is increased. In heavier stages the reactions of regeneration are observed, at which the quality of

reduction changes. It becomes flabby, worm-like, there comes a fast exhaustion of a muscle.

The excitation of activity of a muscle by a pulse electrical current interferes with progress of reactions of

regeneration, keeps a muscle to the period of reinnervation. At electrostimulation restoration of the injured nervous

fiber is also accelerated.

The basic indications to application:

1. Primary atrophy of muscles connected to damage of peripheral

neuron; languid paralyses and paresis.

1. Secondary atrophy of muscles connected with long immobilization,

illnesses of joints.

1. Myopathic paralyses and paresis.

1. Paralyses and paresis of muscles of larynx.

1. Hypomotor dyskinesia of internal organs.

Contra-indications to application: spastic paralyses and paresis.

Dosage: at realization of electrodiagnostics we receive information about functional lability of a muscle,

achieving its minimal, but clearly seen reduction. As a result the parameters of an electrical current for procedure of

electrostimulation are established, that is the doze is defined by results of electrodiagnostics. Procedure of

electrostimulation of muscles is measured out according to:

1) force of an electrical current (up to 50 mA);

1) form, frequency and duration of pulses;

1) duration of procedure (from 5 to 25 minutes);

1) repetition factor of realization of procedures (daily or every other

day);

1) number of procedures for the course of treatment (from 10 up to 25).

The restrictions in quantity of procedures can be connected with irritating action of an electrical current on a skin.

The note: as electrodiagnostics of unstriped muscles is impossible (item 5 of the indications to application),

the doze of an electrical current is selected empirically, it is specified in the directories and manuals on phisiotherapy.

2. Diadynamic currents.

Diadynamic currents (Bernard’s currents) - influence by current with constant direction of a low voltage (60 -

80 v) and small force (up to 50 mA) in a pulse mode. Pulses of half-sine form with frequency 50 or 00 Hz

Two kinds of diadynamic currents (50 hz and 100 hz) apply at the following fixed kinds of modulations (fig.

4):

1) half-wave continuous current;

1) full-wave continuous current;

1) Current modulated by the short periods;

1) Current modulated by the long periods ;

1) half-wave rhythmic current.

1) half-wave wave current.

1) full-wave wave current.

Devices:

- SLPM (sinusoidal low-frequency wave pulse modulate)

- "Tonus";

- "Dyadynamic" (Poland, France).

The basic biophysical processes: same, as at galvanization. The movement of ions in the same direction

occurs during the period, when there is an electrical current there.

The basic physiological reactions and medical effect: same, as at galvanization. The pulse electrical current

with frequency 50 hz causes burning pain, pricking, sensation of large vibration, which is painful and irritating. The

electrical current with frequency 100 hz causes sensation of fine vibration, which is endured much more easily. Basis of

effect of diadynamic currents is anesthetization. The mechanism of this action is considered from positions of the

doctrine of N.E. Vvedensky about features of reaction of a tissue to monotonous irritation. In the first phase of

influence the excitation is observed, at accustoming to excitation there comes a phase of inhibition, then -phase of

parabiosis. The phase of inhibition caused by influence of diadynamic currents, proceeds within 2-4 hours after

procedure, and parabiotic phase is short-termed. The decrease of excitability and functional mobility of nervous

receptors results in anesthetization. At alternation of influence by currents with frequency 50 and 100 hz of

accustoming to irritant does not come. The irritation of receptors of neuromuscular system comes into the central

nervous system. According to the doctrine of A.A. Ukhtomsky in cerebral cortex the majorant of rhythmic irritant is

formed which suppresses painful majorant. In a zone of influence occurs hyperemia of skin, blood circulation and

lymphokinesia, trophism of tissues are improved. The influence occurs mostly on superficial receptors. Before

realization of procedure it is necessary to find pain points, zones of distribution of pain and to impose electrodes on

these areas. The mentioned above reactions are expressed in the greater measure under the cathode, therefore it is

necessary to influence zones of morbidity by a negative pole.

Diadynamic currents can be used also for electrostimulation of muscles, including influence on unstriped

muscles of internal organs in case of their hypomotor dyskinesia by half-wave rhythmic current (former name - rhythm

syncope).

The basic indications to application.

1. Pain syndrome at defeat of peripheral nerves.

2. Pain syndrome at traumas: bruises, stretching of ligaments and muscles.

2. Pain syndrome at degenerative dystrophic defeats of joints and backbone.

2. Local vegetovascular disorders: migraine, Raynaud's syndrome, paresthesia etc.

5. Dyskinesia of internal organs of hypomotor type.

_________________Basic contra-indications to application._________________________________________

1. Acute stages of inflammatory process, especially purulent.

1. Unfixed fractures of bones, dislocations of joints (up to reposition), complete breaks of ligaments

and muscles.

1. Trombophlebitis(in a zone of prospective influence).

1. The presence of stones in a gall-bladder and urinary tracts (if there supposed influence on the

appropriate zones).

Dosage:

1) according to force of an electrical current (up to 50 mA):

2) according to sensations of the patient (light pricking, burning, vibration or rhythmic reduction of

muscles);

3) according to duration of procedure (influence on one field no more than 7 minutes; during one

procedure influence no more, than on three fields);

3) acording to repetition of realization of procedures (two times a day with a break not less than 4

hours, daily, every other day);

3) By quantity of procedures on a rate of treatment (not more than 10).

3. Electrosleep

Electrosleep - influence on the central nervous system by a pulse electrical current of a constant direction,

low frequency (from 1 up to 180 hz) and small force (up to 10 mA in peak value). Pulses of the rectangular form by

duration from 0,2 up to 2 msec. At influence by this current one doubled electrode (cathode) we put on the closed eyes

other doubled electrode (anode) - on area of mastoid (fig. 5).

Fig. 5 Fixing of electrodes at treatment by electrosleep. Devices: - "Electrosleep"

Physiological action: diffuse inhibition in cerebral cortex transforming into sleep. This action considered

from positions of neuro-reflex and direct influence on formations of brain. Neuro-reflex mechanism is connected to an

irritation of receptors of skin, eye-socket and upper eyelid. The irritation from this reflexogenic zone is transferred into

subcortex formations and cerebral cortex, causing reinforcement of processes of inhibition.

At direct influence the electrical current will penetrate through foramens of eye-sockets, being distributed

alongside the vessels into subcortex formations. The electrical activity and functional condition of limbic system

changes. As a result of it there are favorable changes in psycho-emotional sphere.

________________Basic indications to application.__________________________________________________

1. Infringement of night sleep of any etiology.

2. Corticovisceral diseases and functional disorders of the central nervous system.

3. After-effects of craniocerebral trauma, tick-borne encefalitis; diencephalic syndrome.

4. Mental diseases: borderline state, reactive psychosis, schizophrenia.

4. As a component of complex treatment of alcoholism, drug addiction.

4. Pain syndromes of any etiology.

4. Enuresis, nightmares, children's logoneurosis.

4. Exhaustion at intensive intellectual work, work in extreme situations.

The electrosleep can be indicated at many diseases, as the illness breaks a functional condition of the central

nervous system, physiological mechanisms of regulation, corticovisceral relationship.

The main contraindications to application:

1. Acute infectious deteats ot eyes anapenocularcellular tissue.

1. Detachment of retina of an eye.

1. High degree myopia.

1. Adhesive arachnoiditis.

1. Expressed hysteria.

1. Basic glaucoma.

Dosage:

1) according to force of an electrical current (up to 10 mA);

2) according to sensations of the patient (occurrence of the first sensations as light vibration etc.);

3) according to duration of procedure (from 20 minutes up to 1-2 hours);

3) according to repetition of realization of procedures (daily, 4 days in

succession and 2 days of a break, every other day);

3) according to quantity of procedures (10 - 15, maximum is 30).

The electrosleep can be used in a variant named «central electroanalgesia". In this method of treatment the

devices "Lenar", "Elektronarkon", generating electrical pulses of the rectangular form by size up to 5 mA are used.

Frequency of following impulses from 150 up to 2000 hz, duration of pulses from 0,2 up to 0.5 msec. The procedure

will be carried out at forehead-neck arrangement of electrodes. The application of higher frequency of pulses, than in

procedure of electrosleep, allows removing sensations under electrodes. Central electroanalgesia is intended for

potentiation of action or replacement of analgesic and antianxiety pharmaceutical substances, it is used for treatment of

pain syndrome and emotional stresses.

III. Medical application of a pulse electrical current of a variable direction.

In the medical techniques connected to application of the specified physical factor, the tissues are influenced

by a variable sine wave electrical current of average frequency (from 2000 up to 5000 hz). The resistance to this current

from the side of skin is much less, approximately 100 times, than current of low frequency, it will penetrate the tissues

more deeply. In this connection the small part of electrical energy is absorbed by skin, an irritation of skin receptors

sharply decreases, hyperemia does not arise.

Mid-range alternating current is modulated in a current of low frequency. In physics under modulation

(modulatio change, measure) we understand change of amplitude or frequency (or that and another simultaneously)

fluctuations caused by imposing of fluctuations of lower frequency. In this case modulations represent periodic

increases and reduction of amplitude of fluctuations of an electrical current. Separate series of fluctuations ("beat") low

frequency are formed. The medical effect is connected with influence of these "beats" of low frequency on the

neuromuscular apparatus and tissues, which is similar to influence of a pulse electrical current of a constant direction.

Considerably higher carrier frequency provides sharp decrease of irritating action on receptorsp of a skin. It allows to

use an electrical current of the greater force, than in techniques of electrostimulation of muscles and diadynamic

therapy.

1. Interferential currents.

The treatment by interferential current therapy represents influence on tissues by two sinusoidal alternating

electrical currents, which are brought to tissues with the help of two pairs of electrodes (fig. 6).

Fig. 6 The scheme of setting of electrical currents in two independent circuits to a body of the patient: 1 - first

circuit; 2 - second circuit; 3 -electrodes; 4 - surface of a body; 5 - direction of excitation; 6 - area of stimulating action.

The frequency of the first current is constant, it makes in different devices 4000 or 5000 hz. The frequency of

the second current is adjusted in limits from 4001 up to 4100 hz or 5001 - 5100 hz accordingly, i.e. the difference of

frequencies of two currents makes from 1 up to 100 hz. Their interaction in tissues consists in interference of

fluctuations. Some fluctuations are summarized and amplitude of fluctuations of a current grows, others - are mutually

extinguished and their amplitude decreases up to zero. As a result of such interaction in tissues the third current of low

frequency - interferential, representing "packs" of impulses, "beats" (fig. 7) This current has the basic biological

activity.

Fig. 7 The graphic image of formation of interferential currents:

1 - current of the first circuit of frequency 4000 hz; 2 - current of the second circuit of frequency 4100 hz; 3 -

interferential current with constant quantity of beats, which frequency is 100 hz.

Types of interferential currents used in physiotherapy:

1) interferential current of constant frequency in a range from 0 up to

100hz;

1) interferential current with rhythmically varying frequency. Within 15

seconds the frequency of pulses gradually accrues and decreases in a

range:

From 0 up to 10 hz;

from 25 up to 50 hz;

from 50 up to 100hz; from 90 up to 100hz;

from 0 up to 100hz.

Devices:

- "Interdin",

- "Interferentspuls".

Basic indications to application is the same, as at diadynamic therapy. As against it is possible to influence

more significant area and depth of tissues by interferential currents. The local imposing of electrodes is unessential that

allows influencing areas closed by bandages, including plaster. For example, at influence on elbow joint the electrodes

are imposed on a shoulder and forearm.

Basic contra-indications to application same, as at diadynamic therapy.

Dosage according to:

1) force of an electrical current (up to 60 mA);

2) on sensations of the patient (painless vibration);

3) duration of procedure (influence on one field about 10 minutes; during one procedure influence no

more, than on three fields, no more than 10 minutes on each field - in this case general duration of procedure about 30

minutes);

3) repetition factor of realization of procedures (two times a day with a break not less than 3 hours,

daily, every other day);

3) quantity of procedures on a rate of treatment (up to 10, at influence with the purpose

electrostimulation of muscles - up to 20).

2. Sine wave modulated currents.

The sine wave modulated currents (SMC) represent a sine wave variable electrical current by frequency 5000

hz, which is modulated as pulses by frequency from 10 up to 150 hz. Thus series of fluctuations of an electrical current

are formed which are similar to "beats" arising in tissues at interference of two alternating sine wave currents of

different frequencies. As against interferentional currents formed in tissues, SMC are received with the help of the

device and already generated pulses are brought to tissues with the help of electrodes. SMC combine positive properties

of diadynamic and interferential currents.

The kinds of SMC, used in physiotherapy, are represented in a fig. 8.

Fig. 8 Graphic images of the sine wave modulated currents: I - first sort of work (CM); II - second sort of

work (SP); III - third sort of work (SN); IV – fourth sort of work (AF); A - variable mode of operations;B -straightened

mode of operations.

I sort of work (current CM - constant modulation): the carrier frequency of a sine wave current 5000 hz is

modulated by any frequency chosen from a range from 10 up to 150 hz.

II sort of work (current SP - sending of a pause): sending (series of pulses) of sine wave current modulated by

any frequency from a range from 10 up to 150 hz, alternate with pauses.

III sort of work (current SN - sending of the modulated and not modulated fluctuations): sending of a sine

wave current modulated with any frequency from a range from 10 up to 150 hz, alternate with sendings of the not

modulated sine wave current of frequency 5000 hz.

IV sort of work (current AF - alternating frequency): in one of sendings of sine wave modulated current

frequency from a range from 10 up to 150 hz is chosen, in other sending the frequency of the modulated current makes

150 hz.

The duration of sendings and pauses is adjusted separately in limits from 1 about 6 seconds. All kinds of

modulations can be generated in the variable and straightened mode of an electrical current. The straightened mode of

operations, i.e. influence by pulses of half-sine form, are used when influence by an electrical current combine with

influence of medicinal substance (SMC - electrophoresis). Devices: - "Amplipuls" (peak pulsations).

Biophysical processes in fabrics and basic physiological reactions same, as at influence by diadynamic

currents. As against them there are no unpleasant sensations of burning and pricking under electrodes. The basic part of

energy is absorbed by deeply laying tissues, mainly by muscles. There, at cellular membranes and semipermeable

membranes, there appeare short-term changes of ionic concentration causing short-term excitation of nervous and

muscular fibres. There is a sensation of fine painless vibration. The faltering character of influence of series of

fluctuations of an electrical current raises stimulating action of SMC, that is most expressed at II sort of work. Basic

indications to application same, as at diadynamic therapy.

SMC have no irritating action on a skin, which considerably increases endurance of procedure. It allows

using them more widely, than diadynamic currents. The application of SMC is more preferable for children, elder

people.

Contra-indications are the same, as for diadynamotherapy. Dosage according to: 1) force of an

electrical current (up to 80 mA);

2) sensations of the patient (painless vibration);

2) duration of procedure (influence on one field up to 10 mines) i.e: during one procedure influence

no more, than on 3 fields);

2) repetition factor of realization of procedures (two times per day with a break not less than 3 hours,

daily, every other day);

2) quantity of procedures on a rate of treatment (up to 10, at influence with the purpose of

electrostimulation of muscles up to 20).

IV. Medical application of alternating electrical currents and alternating electromagnetic fields of high,

ultra high and superhigh frequencies.

Under influence of a variable electrical current and variable electromagnetic field the charged particles make

oscillatory movements. The frequency of fluctuations corresponds to frequency of an alternating current or field. With

increase of frequency the displacement of ions becomes less meaningful. At high frequencies it makes only 0,01-0,001

diameters of an ion. As ion concentration is not broken, irritating action of these physical factors is not observed. These

features of action allow passing through tissues an electrical current of significant force and electromagnetic high-

power fields. In fabrics thus is allocated meaningful amount of heat, the thermal effect becomes prevailing. Heat is

formed inside tissues and refers to endogenic.

At application of electromagnetic fields of ultra high and superhigh frequencies the reactions are observed

which are impossible to explain only by heating of tissues. The persons professionally connected to influence of these

factors, can have general disorders as neurosis vegetovascular dystonia, endocrinopathy. At powerful influences the

hair can drop out, lens can become dim. The study of such reactions has resulted in representation about oscillator

effect, which is considered as specific, characteristic for the certain frequency of fluctuations. The absorption of energy

of electromagnetic waves in tissues due to fluctuation of ions does not depend on their frequency; the absorption due to

molecules is increased with increase of frequency of fluctuations. This increase occurs up to the frequency, determined

for even one molecule, and in the maximal degree will be shown at concurrence of frequency of the enclosed

fluctuations to own frequency of fluctuations of molecules (phenomenon of a resonance, resonant frequency). It was

found out, that there is "shaking" of lateral circuits of protein molecules, their relaxation.

At high-power influences the fiber can be denaturated, which is accompanied by damage and destruction of

those structures, into which it is included. At small capacities used in physiotherapy, there is an activation of protein

molecules, and accordingly activation of those cells and structures, into which this molecule is included. Hence,

considering individual techniques of treatments connected with use of electrical currents and electromagnetic fields of

various frequencies, in each case it is necessary to estimate as thermal, and oscillator effects to represent, which of

them prevails. The indications to application will depend partially on it at various pathological processes.

Fig. 9 The circuit of an oscillatory contour and influence by its various parts on tissues of the patient

(explanation in the text).

In all physiotherapy devices for reception of fluctuations of various frequencies the generator of high

frequencies is used, which basic element is the oscillatory contour. In a fig. 9 the principle of influence on a tissue of

the patient by various parts of an oscillatory contour in some methods of electrotherapy is shown. At darsonvalism and

treatment by currents of hyperacoustic frequency we influence by an electrical current, the tissue of the patient is

connected thus to a site of an electrical circuit (1). At inductothermia we influence by a magnetic field, tissue of the

patient is located in area of the coil of inductance (2). At ultra high-frequency therapy influence by an electrical field,

the tissue of the patient is located between facing of the condenser (3).

1. Darsonvalism and currents of hyperacoustic frequency.

Darsonvalism is the influence by a variable pulse sine wave electrical current of high frequency (110 or 440

hz), high pressure(voltage) (20 kv) and small force (0,02 MA), The frequency of pulses 50 hz, amplitude of a current in

each pulse gradually accrues and decreases, i.e. the electrical current is modulated on amplitude. The high voltage is

made to tissues with the help of a glass vacuum electrode, in which air is rarefied up to 0,1- 0,5 mm mercury. The name

of this electrode is condenser. Under action of a high voltage air in an electrode is ionized, the electrical current passes

through the ionized gas. It is possible to assimilate conducting part of electrode and a body of the patient to facings of

the condenser, the glass is dielectric. At transition of an electrical current from the ionized gas and capacity of a glass

plate on air arises the spark discharge - disruption of the condenser, and then the electrical current through the patient

goes to the ground. Devices: - "Iskra".

The basic biophysical processes: the effect darsonvalism is connected with irritating action of the spark

discharge on superficial layers of a skin and mucous environments. As the current of very small force is used, the

heating of tissues does not occur. As the influence is carried out by an alternating current of high frequency, the

changes of ion concentration in tissues are not observed, the actions of muscle fibers does not come to light.

Basic physiological reactions and medical action in case of local darsonvalism are local or have segmentation

character. The silent electrical category irritates nervous receptors, causing their functional changes, that results in

small sedative analgesic effect. As a result of nervous - reflex reactions the arterial part of capillaries extends, their

venous part is narrowed, the arterial inflow of blood is increased. Thereof the intensity of exchange processes is

increased, regenerative effect is observed. The appreciable general reactions do not arise. At increase of an air backlash

between an electrode and skin the increase of a voltage submitted on an electrode is required. Capacity of the electrical

discharge in this case raises and becomes spark. The spark discharge causes not only local functional changes, but also

renders cauterizing action, causes inflammatory leukocyte infiltration with moderate edema of tissues. At repeated

influences of the spark discharge signs of damage occur as the centers of micronecrosis of epithelium and of adjacent

connective tissues.

The basic indications to application:

1. Pain syndrome, paresthesia, connected with a defeat of peripheral nervous system.

1. Trophic defeat of a skin, skin itch, loss of a hair.

1. Varicose veins of extremities, haemorrhoidal veins.Lymphostasis.

4. Vegeto-vascular disorders accompanied by peripheral angiospasm (migraine, Raynaud's syndrome).

5. Trophic ulcer, sluggish wounds.

5. Parodontosis, stomatitis, vasomotor rhinitis.

7. The functional disorder of the central nervous system, at which

influence on collar zone, hairy a part of a head (neuro-circulatory dystonia, results of craniocerebral injury etc).

Contra-indications to application: general contra-indications to realization of physiotherapy. The

specific contra-indications are not present.

Dosage according to:

1) intensity of influence, which is adjusted by capacity of the spark discharge designated on a scale of the

device in conditional figures (to specify it in 'watts' is not accepted):

Small intensity (figure 1-3),

Average intensity (figure 4-5),

Large intensity (figure 6-8);

2) sensations of the patient (silent discharge - very weak pricking, spark discharge - expressed

pricking, which at high intensity can be painful);

2) duration of procedure (from 2 to 20 minutes);

2) realization of procedures (daily or every other day);

2) quantity of procedures for a rate of treatment (from 3 up to 30).

The current of hyperacoustic frequency represents a variable sine wave electrical current of high frequency

(22 hz), high voltage (4 kw) and small force. Devices: - "Ultraton".

The same as and at darsonvalism, the influence is carried out with the help of glass vacuum electrodes. There

appeares a silent electrical discharge and sensation of light heat. Biophysical processes in tissues and physiological

reactions are the same, as at darsonvalism. This treatment should be considered as variant of darsonvalism with less

expressed subjective sensations. The basic indications to application are the same. Dosage according to:

1) capacity of influence:

Small (up to 3 wt, there correspond to division 4 scales on the panel of the device);

Average (4-6 wt, corresponds to 5-7 divisions of a scale), - large (7-10 wt, corresponds to 8-11

divisions of a scale).

2) sensations of the patient (very light heat);

2) duration of procedure (from 2 to 20 minutes);

2) repetition factor of realization of procedures (daily or every other

day);

2) quantity of procedures on a rate of treatment (from 3 up to 30).It is noticed, that hyperacoustic

currents possess antiinflammatory and absorbable effect. They are applied as at presence of infiltration without

attributes of suppuration, at comissure processes in a small palvis and abdominal cavity, chronic inflammatory

gynecological diseases, genital infantilism (appropriate cavity electrode is used).

2. Inductothermy

Inductothermy is influence on a tissue by high-frequency (13.56 Mhz) variable magnetic field, which is

formed by an electrical current, passing through the coil (solenoid). Thus except for magnetic the electrical field

making up to 20 % of made energy is formed. At an explanation of action of inductothermy this electrical component is

usually neglected. But strictly speaking, the influence is carried out by an electromagnetic field of high frequency.

Fig. 10. Inductor-disk:1 - general view;

1 - in the disassembled kind.

Fig. 11 Inductor-cable as a flat spiral.

Magnetic field is brought to tissues with the help of a inductor-disk and inductor-cable. An inductor-disk (the fig. 10) represents a flat spiral consisting of three coils of a copper wire made in a plastic skeleton. The inductor-cable is a copper wire in rubber isolation, it is possible to make a various kind of a spiral of it (fig. 11) - flat, cylindrical or as a loop. Between inductor and body of the patient leave a backlash in 1 -2 cm which is provided with that on a part of a body, that undergoes the influence, under inductor we put combined in some layers a towel or a sheet. The creation of a backlash considerably reduces heating of superficial tissues, which is connected with the influence of an electrical field.At use of an inductor-disk, inductor-cable as a flat spiral or loop a magnetic field penetrates in a tissue on depth 5-8 cm. At use of inductor-cable as a cylindrical loop the magnetic field influences all the volume of a tissue (of extremity or trunk). Devices: - "IKV" (short-wave inductothermy).The device is supplied with inductor-disks (small and large) and inductor-cable. By the additional order the complete set of gynecological applicators is delivered: vaginal, lumbar (small, average and large), collar.The basic biophysical processes. The magnetic field, penetrating the tissues, induces in them electrical currents named as induction currents, vortical currents or currents Fuko. The more is the electroconductivity of a tissue, the current of greater force is formed in it. The occurrence of vortical currents is accompanied by heating of tissues. The more electroconductive is the tissue, the more intensively it will be heated up. First of all lymph, blood and parenchymatous organs will be heated up. The skin is heated up unsignificantly, its hyperemia does not arise. Probably, the formation of heat in a skin mostly depends on action of an electrical component of an electromagnetic field. Non-thermal (oscillatory) effect in inductothermia is expressed poorly, but it should be taken into account.The basic physiological reactions and medical effect are connected first of all with effects of heat, which defines the indications to application of this method in physiotherapy. These effects are the following: antispasmodic, sedative, intensifying blood and lymph circulation and metabolism. Resorbable and regenerative effect of heat (in particular at inflammatory processes) is connected with the last effect. In connection with available oscillatory effect it is possible to indicate inductothermy at earlier stages of inflammatory process, than heat therapy. For the account of oscillatory effect it is possible to relate some side-effects of inductothermia: deterioration of coronary blood flow at ischemic disease of heart, deterioration contractility and conductivity of myocardium at diseases of a muscle of heart, reduction of arterial pressure. On the other hand, with oscillatory effect is connected activation of glucocorticoid function of adrenal glands, increase of phagocytic function of neutrophyls, in some researches the increase of a titer of antibodies in blood is shown. The basic indications to application.

1. Inflammatory processes (without suppuration) in a stage of the

resolution.

2. Degenerative-dystrophic and inflammatory diseases of musculoskeletal system.

3. Disease and trauma of peripheral nervous system.

3. Hypermotor dyskinisia of internal bodies.

3. Vegeto-vascular disorders shown by peripheral vasoconstriction.

The basic contra-indications to application.

3. Children up to 5-year's age.

3. Acute stages of inflammatory process, purulent inflammation.

4. Expressed hypotonia, bent to orthostatic collapse.

5. Infringement of thermal sensitivity of skin.

6. Presence of metal subjects in a zone of influence.

Dosage according to:

1) capacity of a magnetic field, which depends on force of an electrical current submitted on inductor. On the

panel of the device "IKV" it is designated by conditional figures from l to 8. At work with the large inductor-disk it

corresponds to force of a current from 160 up to 280 mA and capacity from 40 up to 200 wt;

2) sensations of heat:

low-heat doze (figure 1-3; 160-200 MA; 40-90wt);

Thermal doze (figure 4-6; 220-250 MA; 110-160 wt):

Intensively thermal doze (figure 7-8; 260-280 MA; 185-200 wt);

3) duration of procedure (10-20 minutes, sometimes about 30 minutes);

3) repetition of realization of procedures (daily or every other day):

3) quantity of procedures on a rate of treatment (up to 15).

3. Ultra high-frequency therapy.

Ultra high-frequency (UHF) therapy is an influence on tissues by a variable electromagnetic field of ultra

high frequency (40.68 or 27.12 Mhz). And the advantage is given back to influence of an electrical field. The magnetic

component of made capacity is much less than electrical one. The specified field is made to tissues with the help of

electrodes representing disk condenser plates.

The electrical field UHF penetrates tissues through, penetrating to any depth and being distributed in

environmental space on distance up to 150 meters. The condenser plates, between which the electrical field is formed,

have with an air backlash. The size of a backlash in the sum should not exceed 6 CM at use of portable devices and 8 cm

- at use of stationary devices (for example. 2 CM under one plate and 4 cm - under another). Sometimes for creation of

a backlash use felt linings. At a small backlash the capacity of an electrical field concentrates in superficial tissues, at

the large backlash it is distributed more regularly in superficial and deep tissues. Hence, the size of a backlash is

defined by depth of an arrangement of pathological process. The metal bodies which have got in a zone of influence

"attract" an electrical field. It is hundred properties use for protection of the medical personnel against influence of an

electrical field, placing devices with target capacity more than 100 wt the shielded cabins. Devices: - "UHF" (portable,

capacity up to 100 wt);

"Screen" (stationary, capacity up to 300 wt);

"Pulse".

Each device "UHF" is supplied with three pairs of disk condenser plates: N 1 - diameter of 36 mm, N 2

diameters of 80 mm and N 3 - diameter of 113 mm. The devices "Screen" are completed four pairs disk electrodes (50.

100, 150 and 180 mm in a diameter), having the terminator fixing size of a backlash, and also three pairs of flexible

rectangular electrodes (130 x 80 mm. 180 x 110 mm and 270 x 180 mm).

The basic biophysical processes. The energy of an electrical field is absorbed mainly in tissues having the

large capacitor resistance that is in tissues badly conducting an electrical current. There is an interaction to molecules

having dipole structure. These molecules turn around of an own axis according to changes of polarity of an electrical

field. Besides there is an interaction with electrones, which outside layer is displaced within the limits of a molecule or

atom that results in electronic polarization without formation of an electrical current. Other kinds of polarization are

observed also: ionic, dipole, macrostructural. At significant frequency of a variable electrical field of dipole molecule

have not time to make complete turn, but only change around of the average position. Simultaneously occurs pendular

movement of ions, but infringement of ionic concentration at influence of the specified frequency does not occur, the

irritating action is absent. The different molecules have various own frequency of fluctuations. Mostly those molecules

will change, the own frequency of which fluctuations coincides with frequency of a variable electrical field-resonance

effect. The fluctuations of molecules is called oscillation, and effect connected to these fluctuations, is called

oscillatory. At UHF-therapy oscillatory effect is realized mainly at a level of protein molecules, from which the amino-

acids are rifted. Dispersiveness of protein raises, pH of environment deviates to the acidic side. Oscillatory effect is

connected with a thermal one. The allocation of heat is most expressed in tissues having high specific resistance.

Electroconductive tissues get warm due to a magnetic component of an electromagnetic field, but this effect is small

because of its low power. The basic physiological reactions and medical action are connected with specific oscillatory

and non- specific thermal effects. Oscillatory effect is most important in UHF-therapy. Its influence was studied most

of all at inflammatory processes. With oscillatory effect are connected activation of cellular reactions, formation of a

protective barrier around of the center of an inflammation consisting of crates and elements of a connective tissue,

increase of phagocytic activity of neutrophyls and macrofages. In the center of an inflammation walls of capillaries are

condensed due to mobilization of calcium and loss of fibrin, that promotes reduction of exudation. Bacteriostatic effect

is observed. The given reactions define use of UHF-therapy at acute inflammatory processes, including purulent

inflammation. For reception of anti-inflammatory action thermal effect is reduced to a minimum, definitely dozing

procedure. At later stages of a purulent inflammation the UHF-therapy promotes maturing of abscess, its separation

from environmental tissues, then cleaning of its cavity (necessary condition -presence of outflow of pus). At repeated

influences the formation of a connective tissue is activated.

The electrical field of UHF renders relaxing effect upon smooth muscles of internal organs. At influence on

the limited site of a nervous trunk first of all blocking of sensitive fibres is noticed, painkilling effect is connected with

this fact. The regeneration of the damaged nervous trunk is accelerated.

At UHF-therapy the diverse general reactions are observed, first of all from the side of cardiovascular

system: decrease of arterial pressure, bradycardia, and delay of auricle-ventricular and intraventricular conductivity,

reduction of intensity of coronary blood flow. The high dozes of UHF, exceeding recommended medical, oppress

cellular activity, can cause resistent paretic expansion of vessels, hemorrhage. At high dozes the regenerative ability of

nervous trunks is opressed, the pain in the center of an inflammation amplifies.

The basic indications to application.

1. Inflammatory processes at acute stage, including proceeding with suppuration.

1. Degenerative-dystrophic diseases of organs of movement.

1. Disease of peripheral nervous system accompanying with a pain, including traumatic damage of

nervous trunks.

1. Occlusion defeat of peripheral arteries in an initial stage of disease, peripheral vasoconstriction.

5. Bronchial asthma, gastric ulcer and duodenal ulcer at a stage of aggravation.

The basic contra-indications to application.

1. Sacculated purulent processes.

1. Ischemic disease of heart: progressing stenocardia, heart attack of myocardium.

1. Acute disorders of cerebral blood flow.

1. Expressed arterial hypotony, bent to orthostatic collapse.

1. Pregnancy.

1. Presence of metal subjects in a zone of influence by size more than 4 cm2.

Dosage according to:

1) target capacity of an electrical field, measured in watt. The influence is not recommended: on area of a

head and neck more than 40 wt; on area of thoracic and abdominal cavities - more than 100 wt; on shoulder joints,

elbows, arms - more than 40, 70, 80 wt accordingly; on joints of coxal and knee - more than 70 and 100 wt accordingly;

2) sensation of heat:

pre-heat dozes,

low-heat dozes,

Thermal dozes;

3) On duration of procedure (from 7 to 15 minutes);

3) On repetition factor of realization of procedures (daily or every other

day);

3) By quantity of procedures on a rate of treatment (from 5 up to 15, on

the average 7-10 procedures).

4. Microwave therapy.

The microwave therapy is an influence on tissues of organism by a variable electromagnetic field of

superhigh frequency (microwave). From here other name of this method of treatment - microwave -therapy. For

reception of an electromagnetic field of a microwave the vacuum device magnetron, combining function of an

electronic lamp and oscillatory contour is used. The source of electrons in magnetron is served by the cathode. The

electrical field between the cathode and anode accelerates movement of electrons. The small-sized constant magnet,

which magnetron is supplied with, creates a magnetic field directing movement of electrons. The electromagnetic field

of a microwave is brought to tissues with the help of special oscillators of the directed effect, which represent dielectric

aerial. Oscillators are used on contact and remote techniques of influence. At remote influence the device is established

in the shielded cabin so that oscillator was directed to outside wall.

Used in physiotherapy domestic devices generate an electromagnetic field of frequency 2450 mHz (length of

a wave 12,24 cm), 2375 mHz (length of a wave 12,6 cm), 450 mhz (length of a wave 65 cm). The waves of length

12,24 and 12,6 cm concern to a centimetric range, and wave of length 65 cm - to decimeter. From here name of two

kinds of microwave therapy: cantimeter wave therapy (CW-therapy) and decimeter wave therapy (DW-therapy). The

microwaves have properties of reflection, refraction, interference, diffraction. They can be concentrated in a narrow

bunch.

Devices:

a) For CW-therapy:

"Beam - 58", "Beam - 11", stationary, capacity up to 150wt;

"Beam - 2", "Beam - 3", portable, capacity up to 20 wt.

b) for DW-therapy:

"Volna", stationary, capacity up to 100 wt;

"Romashka", portable, capacity up to 12 wt;

"Ranet", portable, capacity up to 25 wt.

At application of stationary devices the influence will be carried out on a remote technique. At use of the

device "Beam - 58" or "Beam - 11" the air backlash between oscillator and surface of a skin makes 5-7 CM, at use of the

device "Wave" - 3-4 cm. The portable devices are completed by oscillators for remote influence, and for contact as

well. Three oscillator of the cylindrical form for contact influence through skin are included into set: by a diameter of

20 mm (N 1), 35 mm (N 2) and 115 mm (N 3), and also two cavity oscillators, filled by ceramics, which are not heated

up at realization of procedure: vaginal (N 3) and rectal (N 4). The basic biophysical processes essentially do not differ

from those at UHF-therapy. The resonant absorption of microwaves by separate parts of protein molecules, relaxation

of their lateral circuits is observed. Electrical active elements of cells change, on which the permeability of membranes

depends. The influence on polypeptides, some aminoacids is carried out.

The energy of microwaves is absorbed mainly by molecules of water, their dielectric permeability in this

connection is insignificant. At influence of microwaves of a centimetric range dipoles of water have time to turn

completely for one change of a mark of polarity. The absorption of their energy occurs first of all in tissues, rich in

water. The degree of reflection by surface of skin is significant, but it is not possible to take it into account at dozing of

procedure. Depending on thickness of subcutaneous fatty layer and features of an arrangement of oscillator is reflected

from 25 up to 75 % of energy of microwaves, on the average about 40 %. Their reflection from borders of other tissues

is significant: skin -hypodermic cellular tissue, hypodermic cellular tissue - muscle. Thus the formation of so-called

"standing" waves in tissues is possible. They are formed at reflection of a wave from border of two environments and

imposing reflected on the next falling wave. Such process occurs repeatedly in the same place. Under the laws of

physics the "standing" wave is formed in case if distance between borders of two environments makes more than a

quarter of length of a wave. This situation can arise at thickness of subcutaneous fatty layer more than 2 cm.

The microwaves of a decimeter range are approximately 2 times less intensively reflected by a surface of

skin. They to a lesser degree, than wave of a centimetric range, are absorbed by water, as the phenomena of a resonance

of dipoles of water at this frequency of an electromagnetic field are less expressed. The energy of these waves in

process of penetration into depth of tissues fades twice more slowly in comparison with centimetric waves.

The specified biophysical processes are accompanied by allocation of heat in tissues sated with water. Is

present oscillator effect indissolubly connected with thermal.

The basic physiological reactions and medical action are connected with specific oscillatory and non- specific

thermal effects. With oscillatory the effect is connected anti-inflammatory action of microwaves, antiallergic effect,

positive influence on immunogenesis. In spite of the fact that the action of microwaves is distributed to small volume of

tissues, the general reactions can be observed. They are realized mainly through amplification of function parasympatic

department of vegetative nervous system: decrease of arterial pressure, decrease of number of reductions, delay of

intraventricular conductivity to heart. Stimulation of synthesis of some prostaglandines is observed. The warming up of

tissues at CW-therapy occurs on depth of 3-5 cm. At formation of "standing" waves there is a significant local increase

of temperature of a tissue down to a burn. This overheating of a tissue is accompanied by sensation of bursting open,

burning, rheumatic pains that requires immediate reduction of a doze of influence or termination of procedure. The

uncontrollable overheating can arise at influence on hydropic tissue.

At DW-therapy the warming up of tissues occurs on more significant depth making 8-10 cm. The probability

of formation of "standing" waves is insignificant also warming up of tissues is more uniform. To thermal effect of

microwaves are connected anti-spastic and sedative action, intensification of blood- and lymph-circulation in tissues,

intensification of metabolism. It is necessary to remember, that oscillatory and thermal effects are inseparable,

are shown simultaneously.

_____________________Basic indications to application._____________________________________________

The choice of CW- or DW-therapy depends on depth of an arrangement of pathological process.

1. Inflammatory processes in acute, subacute and chronic stages proceeding without suppuration.

1. Degenerative-dystrophic and inflammatory injuries of the

musculoskeletal system.

1. Disease of perypheral nervous system accompanying with a pain, including traumatic damage of

nervous trunks.

1. Hypermotor dyskinesia of internal organs.

1. Occlusive defeat of peripheral arteries in an initial stage of disease, peripheral angiospasm.

The basic contra-indications to application.

1. Children up to 5-year's age.

1. Ischemic disease of heart: progressing stenocardia, cardiac infarction.

1. Acute disorders of cerebral blood circulation

1. Disorder of thermal sensitivity of skin.

1. Presence of metal subjects in a zone of influence by size more than 4 cm2.

Dosage according to:

1) target capacity of an electromagnetic field, measured in watt;

2) sensation of heat;

At a remote technique of influence the following dozes are distinguished:

weakly thermal, up to 40 wt;

thermal, from 40 up to 60 wt;

intensive thermal, more than 60 wt.

At a contact technique of influence the following dozes are distinguished:

weakly thermal, up to 3 wt;

Thermal, from 3 up to 6 wt;

intensive thermal, more than 6 wt.

3) duration of procedure (from 5 to 20 minutes);

3) On repetition factor of realization of procedures (daily or every other

day);

3) By quantity of procedures on a rate of treatment (from 5 up to 20).

Magnetotherapy.

Magnetotherapy is a medical influence by a magnetic field on organism as a whole or its separate tissues. The

magnetic fields arise where an electrical current passes. The power lines of a magnetic field as the closed concentric

circles surround a trajectory of a driven electrical charge. The direction of power lines of a magnetic field depends on a

direction of an electrical current.

At use of a constant electrical current there is a constant magnetic field (field of a constant direction). At use

of a variable electrical current there is a variable magnetic field (field of a variable direction), which frequency is

defined by frequency of an electrical current, having it. In physiotherapy a magnetic field of frequency up to 200 hz is

more often used. The constant and variable magnetic fields can be applied as in continuous and faltering modes.

The basic power characteristic of a magnetic field is the magnetic induction, which is measured in Teslaes

(Tl). In physiotherapy the thousand parts of Tesla - milliTeslaes (mTl) are used. In process of removal from a

conductor of an electrical current the induction of a magnetic field decreases directly proportionally to square of

distance. Source of a magnetic field in physiotherapeutic equipment is multiturn coil from a metal wire. The influence

is carried out with the help of a inductor-electromagnet and inductor-solenoid.

The inductor-electromagnet (fig. 12) consists of ferromagnet core and metal winding around it, on which the

electrical current moves. Greatest density of power lines of a magnetic field is created on face parts of inductor,which

are used at treatment. These inductors are intended for realization of local procedures.

Fig. 12 Inductor-electromagnet and its magnetic field: 1 - core; 2 - winding.

The inductor-solenoid (fig. 13) represents multiturn coil from a metal wire without the core, on which the

electrical current moves. Maximal density of power lines of a magnetic field is created inside the solenoid. This

inductor is intended to influence extremities and trunk of the patient, which are located inside of the solenoid. In some

devices the electrical current moves on separate coils of the solenoid consistently, with a delay on a phase. Thus

"running" of an electrical current along the inductor occurs in form of wave that creates a so-called running magnetic

field.

The voltage of electrical current feeding inductors is not more than 40 wt. The form of a magnetic field

depends on the characteristics of an electrical current feeding the inductor. The constant magnetic field (CMF) is raised

by a constant continuous electrical current, has a constant direction of magnetic power lines and constant magnetic

induction (1 in a fig. 14).

Fig. 13 Inductor-solenoid and its magnetic field.

The variable magnetic field (VMF) is raised by a variable electrical current of the sine wave form, is

characterized by a variable direction of magnetic power lines and varied meaning of a magnetic induction (2 in a fig.

14). The pulse magnetic field (PMF) is raised by pulses of a constant electrical current, it is usual half sine wave form,

the direction of magnetic power lines is constant, the magnetic induction varies under the pulse law, periodically

reaching zero (3 in a fig. 14). Each of the forms of a magnetic field is used in continuous and faltering modes of

operations. The faltering mode is characterized by alternation of sendings and pauses. Devices:

a) stationary:

- "Polus-g", influence by a variable magnetic field by frequency 50 hz or pulse (pulsing) magnetic field by

frequency 50 hz. Mode of operations continuous and faltering. At a faltering mode duration of a sending 2 seconds,

duration of a pause 2 seconds. Five inductors-electromagnets of different size are included into a complete set. Use of

two inductors simultaneously is possible.

Fig. 14 Graphic images of the various forms of magnetic fields: 1 -constant magnetic field (CMF); 2 -

variable magnetic field (VMF); 3 - pulse magnetic field (PMF). Modes of operations: And - continuous; - faltering.

- "Polus-2", differs from the previous model only by that enables to change frequency of a magnetic field

from 10 up to 50hz.

- "ALIMP-G" (device for treatment by a pulse magnetic field), influence

by a running pulse magnetic field, frequency of pulses 10 or 100 hz, form of pulses is half-sine wave. Eight inductor-

solenoids, large and small are included into a complete set. Inside of the large solenoid we put injuried extremity. Small

solenoids we put on a surface of a body, thus it is possible to use an extra packing with pockets, in which we place

solenoids.

- "Avrora MK-G" (development of the Ryazan radio engineering

academy) - influence by a running pulse magnetic field, frequency of pulses from 1 up to 100 hz, and running constant

magnetic field. Inductor-solenoids are made out as a survival suit, in which extremities, trunk and head of the patient

are located. It is intended for influence on all organism or its separate parts by a combination of the specified magnetic

fields. 6) Portable.

"MAG - 30", one of the simplest designs for magnetotherapy. The bottom surface of the device is

its working part. The influence is carried out by a variable magnetic field by frequency 50 hz with the help of the

inductor-electromagnet which has been built in the device. The parameters of a having electrical current, and

consequently also of magnetic field, are not adjusted.

"Polus - 101", influence by a variable magnetic field. The device is supplied with two inductor-

solenoid: N 1 generates VMF by frequency 1000 hz, N 2 - 700 hz. Mode of operations is continuous or faltering. At a

faltering mode duration of a sending 1,5 seconds, duration of a pause 1,5 seconds. In work is used either one inductor,

or both together (on different extremities).

- "AVIMP" (device of influence by a pulse magnetic field), frequency of pulses from 10 up to 130 hz. Three

inductor-electromagnets are included into a complete set. Mode of operations is continuous. The basic biophysical

processes.

Magnetic field passes through organs and tissues of the man freely. The influence can be carried out through

clothes, various bandages, including plaster. On a picture of a magnetic field in air it is possible to judge about its

distribution in tissues and depth of penetration in a body of the man. At use of a inductor-electromagnet the depth of

influence reaches 7-8 cm. At use of the inductor-solenoid the influence is carried out on all volume of a tissue placed in

the solenoid.

The magnetic field causes the physico-chemical phenomena in tissues at a molecular level. Thus the

important role is played by magnetic and electrical properties of molecules which are included in structure of biological

structures.

Under action of a magnetic field in liquid environments of the organism, possessing high electroconductivity,

the electrical current is induced. In view of small intensity of a magnetic field used in physiotherapy, the size of an

electrical current is insignificant and thermal effect practically does not arise. The constant magnetic field induces an

electrical current in blood driven along blood vessels, that effects condition of cellular and non-cellular components of

blood. This prompting in that case is most expressed, when the power lines of a magnetic field are perpendicular to a

direction of movement of blood.

The variable and pulse magnetic fields induce an electrical current first of all in resting biological fluids, that

results in change of volumetric electrical charges about membranes and in areas adjacent to membranes. As a result of

it the positive and negative charges are distributed non-uniformly, macroscopic volumetric charges are resorped. All

this has an effect for permeability of membranes, intensity of exchange processes in cells.

Between an external magnetic field and driven electrical charge there is a mechanical interaction as an

attraction and pushing away. Such interaction is named a magnetomechanic effect. It is caused by presence at a driven

electrical charge of an own magnetic field. Magnetomechanic effect is shown first of all at a level of nervous and

muscular tissues, as these fabrics are carriers of biocurrents, source of biomagnetic fields. This effect also is

accompanied by change of permeability of membranes, speed of cellular metabolism processes and connected with

them changes of activity of cells.

Probably, the effect of "magneting" of water participates in the mechanism of action of a magnetic field.

Specify, that optical density and some other properties change its electroconductivity. Intracellular water, hydrate of

covers of protein molecules is to the greatest degree undergo these changes.

The basic physiological reactions and medical action.

At influence by a magnetic field the majority of the patients does not have any sensations, as receptors of skin

are not irritated, the meaningful quantity of endogenous heat is not formed. The part of the patients marks in a zone of

influence easy pricking or warming. The energy of a magnetic field is to the greatest degree absorbed by a nervous

tissue. At influence on a head and collar area raises force of brake processes in the central nervous system, that is

shown by distinct sedative effect. The influence on hypothalamus - highest vegetative centre is significant. The

normalization of broken vegetative functions, stimulation of production of hormones by peripheral endocrine glands is

observed.

At influence on peripheral nervous system the increase of a threshold of sensitivity of nervous receptors is

marked, that is shown by moderate anesthetic effect. The acceleration of restoration of the damaged nervous trunk is

observed trophic and regenerative action.

The influence of a magnetic field on cardiovascular system is significant. At direct influence on area of heart

or its reflexosegmental zone moderate bradycardia develops, the ratio between coronary blood flow and need of

myocardium in oxygen is improved, that is connected with moderate betaadrenoblocking action of a magnetic field. At

influence on a head and collar area the hypotensive effect is observed. Peripheral arteries of muscular type such as

arteriolas extend under influence of a magnetic field that is connected with its direct myotopic effect on vessels.

Aggregation ability of thrombocytes is simultaneously reduced; raises fibrinolytic activity of blood, the content of free

heparine in it is increased. All this improves regionary blood flow and perfusion of tissues. The influence of a magnetic

field on peripheral blood flow is favorable. The specified effects promote wide application of a magnetic field in

treatment of diseases of peripheral vessels, arteries and veins. Its use is especially popular at occlusive defeats of

arteries of extremities and brain vessels, peripheral vasoconstrictions.

Antiinflammatory effect of a magnetic field is noticed. It stimulates regeneration processes in tissues, which

integrity is broken inflammatory process. The healing and restoration of function of a tissue is accelerated at any other

reason of damage: traumas, ulcerative processes, degenerative-dystrophic disease. All this allows speaking about

trophicostimulating action of a magnetic field. Appreciably this promotes improvement of rheological properties of

blood and intensification of microcirculation.

The antiallergic action of a magnetic field is described. It is connected, probably, with stabilization of

membranes of corpulent cells, that prevents process of their degranulation. The influence of a magnetic field on the

contents of T- and B - lymphocytes, level of immunoglobuline of blood is marked also. In experiment

immunocompetent organs have appeared very sensitive to influence by a magnetic field.

Hence, the magnetic field has wide and diverse action on organism of the man in norm and pathology. It is

weaker irritant, than majority of factors used in physiotherapy, therefore its action is very soft and physiologic.

The answer-back reactions are most expressed at influence by a pulse magnetic field is especial at its

frequency up to 20 hz. A more poorly variable magnetic field and the softest action render a constant magnetic field.

The physiological and medical effects of a magnetic field are observed after repeated influences, but the achieved effect

is kept within several months. Magnetotherapy is one of the most sparing methods of influence, it is easily transferred,

it is not accompanied by any obvious subjective sensations and general reactions, and it is well combined with

influence of a number of other physical factors. All this allows to apply magmetotherapy widely at the patients of

various age, from children's up to senile, including at presence the heavy accompanying pathology suffices.

The basic indications to application.

1. Functional disorders of the central nervous system, corticovisceral disease.

1. Inflammatory processes in subacute and chronic stages proceeding without suppuration.

1. Diseases of allergic genesis: bronchial asthma, vasomotor rhinitis, hives, Quincke's edema.

1. CHD: stable stenocardia of a pressure of I - III of functional classes.

1. CVP: infringement of cerebral blood circulation, ischemic insult

(since the fifth week of disease).

1. Occlusive defeat of peripheral arteries, peripheral vasoconstriction.

7. Disease of peripheral veins: thrombophlebitis, chronic venous

insufficiency.

8. Degenerative and inflammatory defeat of musculosceletal system.

8. Disease of peripheral nervous system accompanied by pain.

Contra-indications to application.

1. Diencephalic syndrome.

1. The expressed disorderss of function of endocrine glands, especially

hyperthyroidism.

1. Arterial hypotony, susceptibility to orthostatic collapses.

Dosage acording to:

1) Size of a magnetic induction in milliTeslaes (mTl) on an exit from a surface of inductor:

Up to 35 mTl in devices "Pole - r" and "Pole - 2",

Up to 30 mTl in the device "MAr-30",

Up to 10 mTl in the device "ALIMP-1",

Up to 5 mTl in the device " Avrora MK-1 ",

Up to 1,5 mTl in devices "Pole 101" and "Avimp". Size of a magnetic induction is not the same for

inductors of different types from

a complete set for one device. The appropriate instructions are available in the directories and instructions to

use of the device;

2) The form of a magnetic field (constant, variable, pulse, running);

3) Mode of operations of the device (continuous, faltering);

4) Duration of procedure (from 10 to 30 minutes, at consecutive

influence on some fields about 60 minutes);

5) Repetition factor of realization of procedures (daily or every other

day);

6) By quantity of procedures on a rate of treatment (from 10 up to 25).

Phototherapy

Phototherapy is use of artificially received light energy with the medical and preventive purposes. The

treatment by solar light (heliotherapy) is referred to section of climatotherapy.

Light flow (the optical radiation) represents electromagnetic waves, which as against radiowaves are

distributed not continuously, but as separate portions (quantums, photons). Phenomena of refraction, absorption,

dispersion, reflection from border of two environments are peculiar to it. The range of light waves from 400 microns up

to 180 nm is used in physiotherapy. [1 micrometer (the micron) makes 1CG6 of meter, 1 nanometer (nm) -10 meters].

The optical range is divided into three areas: infra-red (from 400 microns up to 760 nm), seen (from 760 up

to 400 nm) and ultra-violet (from 400 up to 180 nm). From infra-red (IR) to ultra-violet (UV) to radiation length of a

wave of electromagnetic fluctuations decreases, the energy of quantum grows, that is the energy of quantum is back

proportional to length of a wave. The direct dependence between energy of quantum and depth of penetration of light

waves in a tissue of the man is not present. Long-wave IR rays have so small energy, that are absorbed by a homy layer

of skin. In process of reduction of length of waves and, according to this, increase of energy of quantum the depth of

their penetration in a tissue is increased, reaching 4-5 cm in the field of short IR rays and red part of seen area. Further,

despite of proceeding increase of energy of quantum, the depth of penetration of light waves begins to decrease, as the

ability of tissues is increased to absorb a light flow. The rays of seen area will penetrate into depth of tissues on 1-3 cm,

and UV rays - not further than 1 mm.

1. Infra-red irradiation.

Source of IR rays is any heated up body. Its radiative ability is measured by capacity of a light flow

expressed in Watts. It is proportional to the fourth degree of temperature of the heated up body (law of Stethen and

Boltsman), that is at increase of temperature of a body twice its radiative ability grows 2-16 times. Hence, for reception

of a stable flow of IR rays temperature of their source should be strictly constant.

Length of a wave of a light flow also depends on temperature of a body, radiating it. Length of a wave, to

which there corresponds maximum of radiation, is back proportional to absolute temperature (law of Vien). Absolute

temperature is expressed in Kelvin degree (1 *K = - 273C). According to this law the maximum radiation of the sun is

necessary on a green part of seen area (0,52 microns). The body of the man radiates long-wave IR spectrum (9,6

microns).

IR light area is divided into some zones. In physiotherapy it is convenient to divide it into two zones: nearest

IR in length of a wave from 0,76 microns (760 nm) up to 1,5 microns far IR in length of a wave more of 1,5 microns.

The terms "nearest" and "far" zones reflect affinity or remoteness from seen area. The rays of nearest IR zone will

penetrate in a tissue on more significant depth (4-5 cm), therefore first of all they are used in the medical purposes.

For reception of IR radiation use calorific sources. To requirements, showed to them, to the utmost

correspond incandescent lamps,used for illumination. Their string is warmed up to 2500 - 2800* K, maximum of a light

flow, according to the law of Vien, falls on length of a wave about 1 micron, that corresponds to nearest IR zone. About

75 % of energy consumed by incandenscent lamps, is spent for production of IR rays, about 12 % - on seen light area,

other energy is lost by other ways. If we take into account only nearest IR zone, in a lamp by capacity 100 wt it makes

about 35 %, and in lamps from 500 up to 1000 wt - about 40 %. The usual glass passes IR rays with length of a wave

less than 2,5 microns. Hence, the incandenscent lamps are favourable as sources IR rays and are unprofitable as sources

of illumination.

For reception of IR rays with length of a wave more than 3 microns use open radiators as tungsten

filament,wound on the ceramic core. Temperature of such radiator is selected according to required length of a wave of

radiation.

Devices:

- lamp "Sollux" (sol - sun, lux - light, Latin.) Stationary on a support or desktop (portable);

Lamp (reflector) of Minin;

Local electrolight a bath. In different by size baths is used from 8 up

to 16 incandescent lamps by capacity 40 wt each;

Lamp of infra-red rays, stationary on a support or desktop. Open radiator is used in it.

The basic biophysical processes occur at a molecular level. The

molecules receive additional energy and their Brownian motion increases, they become more active. Temperature of

tissue raises. The part of IR rays is reflected from a surface of a skin, their absorption on depth quickly accrues. The

rays of length of a wave more than 1,5 microns are especially intensively absorbed by water. The basic physiological

reactions and medical action are caused by thermal effect. This warmth is exogenous, IR rays are named also as thermal

rays. First of all receptors of skin and vessels of superficial tissues are irritated. Externally it is shown by thermal

erythema, of non uniform on intensity having indistinct borders. Erythema occurs during an irradiation, keeps no more

than 30 minutes after termination of procedure. At an irradiation of the appropriate sites of skin it is possible to count

on reaction from the side of internal organs by the mechanism of vegetative-segmental reflexes: expansion of vessels

and connected with it intensification of blood circulation, activation of metabolism. The effects of heat define the

indications to application of IR rays: antispasmodic and sedative action, intensification of blood and lymph circulation,

exchange of substances in tissues. Its effect is considerably less expressed in comparison with other methods of

physiotherapy, at which use formation of endogenous heat occurs. The general answer back reactions usually are not

observed. It allows applying IR rays at presence of quite heavy general pathology.

_________________Basic indications to application._______________________________________________

1. Inflammatory processes (without suppuration) in a stage of the

sanction.

2. Degenerative-dystrophic and inflammatory diseases of musculoskeletal system.

3. Disease of peripheral nervous system accompanied by pain.

3. Consequence of traumas with the purpose of pain-killing (bruises, stretching of ligaments).

5. Contraction of muscles of spastic type (before medical gymnastics and massage).

The basic contra-indications to application.

1. Acute stages of inflammatory process, purulent inflammation.

1. Disorder of thermal sensitivity of skin.

Dosage according to:

1) sensation of heat, which is regulated or distance from a source of an

irradiation, or rheostat, giving an opportunity to adjust force of an

electrical current which is taking place through a source of IR rays and

by that to change its degree of incandescence .

2) duration of procedure (from 15 up to 60 minutes);

2) repetition factor of realization of procedures (two times per day or daily);

2) By quantity (amount) of procedures on a rate of treatment (up to 25).

2. Ultra-violet irradiation

For reception of UV rays we use luminescent light sources representing a lamp AMT (arc mercury tubular).

Its former name SMQ (straight line mercury-quartz). Lamp AMT is a tube of cylinder form made of quartz or uviol

glass, which passes UV rays. In end parts of tube metal electrodes are soldered in for connection with a source of an

electrical current. Air from tube is removed and is replaced easily by ionized argon. In a tube there is a small quantity

of mercury turning during work of tube into vaporous condition. Through the tube passes an electrical current of a

voltage 120 v and force up to 4 A. Thus vapors of mercury begin to shine. Up to 70 % of a light flow make UV rays,

rest is seen area, mainly violet, light-blue and green zone.

UV area of radiation is divided into three zones: long-wave from 400 up to 320 nm, middle-wave from 320

up to 280 nm and short-wave from 280 up to 180 nm. From positions of practical physiotherapy the allocation of a zone

of long-wave ultra-violet rays (LUV) and zone of short-wave ultra-violet rays (SUV) is important. LUV and SUV

radiation are combined with middle-wave one, which specially is not allocated.

The sources of UV radiation we divide into integrated and selective. The integrated sources radiate all UV

spectrum, selective any zone, which is short- or long-wave one. The spectrum of radiations required for medical

application, is provided with mode of operations of a lamp in sources of an integrated flow or SUV rays, or special

covering of its internal surface detaining SUV rays, in sources of LUV rays. Devices:

a) sources of an integrated flow UV rays:

- IMQ (irradiator mercury-quartz) on a support;

- UGD (ultra-violet group desktop) irradiator, or IN (irradiator of

nasopharynx), stationary device for the group located irradiations of

tonsils, acoustical pass, mucous environments of a cavity of a mouth and

nose. It is completed by the appropriate tubes;

- irradiator such as "Mayak" for general group irradiations;

b) The sources of SUV rays, in which are established arc bactericidal (AB) lamp, or AMT lamp , fed by an

electrical alternating current UHF, MICROWAVE;

BIR (bactericidal irradiator remote) on a support;

BIP (bactericidal irradiator portable);

SUVI (short-wave ultra-violet irradiator), for the individual located

irradiation of tonsils, auditory meatus, mucous environments of nasal cavity and mouth.lt is completed by the

appropriate tubes.

- BIS (bactericidal irradiator on a support), WBI (wall bactericidal

irradiator). BMI (bactiricidal mobile irradiator), are intended for an

irradiation of premises:

c) The sources of LUV rays, in which are established luminescent erythema lamp (EL):

- EGR (erythema group remote), for general group irradiations;

- EMI (erythema mobile irradiator), includes except EL lamp two

incandescent lamps with capacity of 500 wt; it is intended for general

group irradiations.

Except for the device EMI other devices for combined influence by UV and IR rays are produced. For

example, portable device «Electronics UFO-01-250H".

The basic biophysical processes occur at an electronic level. Electrones move from one power level to the

other, a higher one, having received energy from UV quantum for overcoming an attraction of a nucleus. If the energy

of UV radiation is great enough, electrone is beaten out from an external orbit. The particle which has lost electrone,

becomes positively charged, and accepted the beaten out electron - negatively charged. These processes of moving of

electrones are named as photoelectric effect. As a result of such processes atoms and the molecules are made active, the

electrical properties and disperciveness of colloids of cells change, that influences their ability to live. UV rays render

photochemical action, which displays processes of photoisomerization. In molecules there is an internal regrouping of

atoms without change of chemical structure of substance. Thus the biological object gets new chemical and biological

properties.

Under influence of UV rays there is a process of photooxidation strengthening of oxidizing reactions in

tissues.

The basic physiological reactions and medical action.

Distinguish direct (local) and general action of UV rays. The general action includes humoral, neuroreflex

and vitaminoforming. Using various dosage and techniques of an irradiation it is possible to receive prevalence of

this or that action.

The direct action is shown in a skin, deep into with which UV rays will penetrate not further 1 mm. Thermal

action they don't have (" cold rays "). SUV rays are absorbed first of all by proteins contained in a nucleus of a cell,

LUV rays - by proteins of protoplasm. At intensive enough and long influence comes denaturation and coagulation of

protein, as the result is necrosis of epidermis cells, aseptic inflammation. The lost protein is split by proteolytic

enzymes. Thus the biologically active substances are formed: histamine, serotonin, acetylcholine and others, the

quantity of products of oxidation, first of all lipids peroxides is increased.

The externally local action is shown by formation of UV erythema, the skin becomes slightly hydropic and

painful, its temperature raises. This erythema is uniform, with precise borders, occurs through the certain latent interval

of time: under action of SUV rays in 1,5-2 hours, LUV rays in 4-6 hours. The maximal intensity it reaches in 16-20

hours, some days, gradually dieing away keep. Erythema keeps longer, caused by LUV rays. The skin of a stomach is

most sensitive to UV rays. Further on a degree of decrease of sensitivity come: skin of a breast and back (about 75 % in

relation to sensitivity of skin of a stomach), outside surface of a shoulder (75- 50 %), forehead, neck, hip, calf (50-25

%), back surface of hands and feet (25 %).

At repeated influences on the same part of skin the accomodative reaction to action of UV rays develops. It is

shown by a thickening of a horn layer of skin and adjournment of a pigment melanin. Melanin is formed in 3-4 days

after occurrence erythema. Pigmentation is possible without preliminary formation of erythema. Melanin protects more

deeply laying tissues from superheating, absorbing seen and IR rays. Melanin itself hardly protects from influence of

UV rays, as it is formed in basal layer of skin, where they will not penetrate. The pigment is formed under action of UV

rays. The rays of a zone SUV have powerful bactericidal action; with this purpose they are mainly applied. UV rays

stimulate activity of cellular elements of skin that is confirmed by increase of quantity of mitosis. In result the

processes of epithelization are accelerated, the formation of a connective tissue is activated. In connection with such

action they are applied to treatment of slowly healing wounds and ulcers. The activation of neutrophyls and

macrophages increases resistibility of skin concerning an infection that is used for treatment and preventive

maintenance from pustular defeats. Under influence of erythema dozes of UV rays the sensitivity of nervous receptors

of skin is reduced, the part of them collapses, subsequently being restored. Such action is the indication for application

UV rays with the purpose of pain-killing.

General humoral action of UV rays is connected with absorption and fall of biologically active substances

formed in skin into blood flow. This action is usual is considered on an example of histamine, physiological antagonists

which are catecholamine: adrenaline and noradrenaline. If the quantity of histamine and other biologically active

substances is so great, that the activity of sympathoadrenal system is unsufficient for neutralization of their action, the

general pathological reactions prevail, that is observed at an irradiation by erythema dozes of the large surfaces of skin.

In this case can arise destructive changes in adrenal glands. The repeated applications of medical dozes of UV rays

stimulate by humoral mechanism of sympathoadrenal and hypophysis-adrenal system, function of cortex of adrenal

gland, thyroid and sexual glands, that at the end raises their serviceability. Such influence creates effect of training.

Among humoral effects of the special attention the activation of reactions of immunity deserves stimulation

of immunobiological protection of the organism. The following things are noticed: the increase of the contents of

immunoglobulines in blood, titer of complement at its initially low size, phagocytory activity of neutrophiles of

peripheral blood. Is found out, that UV rays possess desensitizing action. General neuroreflex action of UV rays is

connected with an irritation of extensive receptor system of skin. As a result of regular general irradiations answer-back

of reflex reaction are improved, that is expressed in decrease of generalization of reflex answer and amplification of

local protective reactions. Anti-pain action of UV rays is observable at a local irradiation, is connected not only with

influence on receptors of skin, but also creation of a majorant in the central nervous system. The small dozes at a

general irradiation stimulate receptors of skin and by reflex way stimulate activity of the central nervous system. The

influence on endocrine glands is realized not only by humoral mechanism, but also by means of reflex of influences on

hypothalamus.

With the account of so close interaction of humoral and neuroreflex mechanisms, the theory of general action

of UV rays we consider as neurohumoral.

Vitamin-forming action of UV rays consists in stimulation of synthesis of vitamin D. It is connected with

physico-chemical action of a zone LUV rays - process of photoisomerization. From provitamines, taking place in fat of

sebaceous glands of skin, the vitamin D is formed: from ergosterin - vitamin D2, from 7-dehydrocholesterine - vitamin

D3, from 2,2 - dehydroergosterine - vitamin D4 is formed. The influence of UV rays on phosphoric-calcium exchange,

their antirachitic action is connected with formation of vitamin D. The rays of a zone SUV do not have such effect.

_____________________Basic indications to application._____________________________________________

a) Local irradiation:

1. Limited defeats of skin and mucous environments with the purpose of

bactericidal action,stimulation of healing: infected wounds and ulcers, erysipelas of skin, irradiation through a tube at

diseases of palatinetonsils, mucous cavity of a mouth, gullet, external auditory meatus.

1. Disease of peripheral nervous system accompanied by pain, first of all at acute stage.

1. Arthritis (polyarthritis), hypertrophic arthritis, acute and exacerbation of chronic ones.

1. Inflammatory diseases of internal organs in acute and subacute stages (for example, organs of a

small pelvis, bronchus, lungs); influence on appropriate reflexogenic zone of skin.

1. For desensibilization (for example at bronchial asthma by fields on chest).

b) General irradiation:

1. Tempering, increase of stability to infectious diseases.

2. Indemnification of natural UV insufficiency (work in mines, underground, conditions of north).

3. Rachitis of children - treatment and preventive maintenance; fractures of bones in a stage of

rehabilitation (with the purpose of mobilization of

phosphoric-calcium exchange through formation of vitamin D).

The basic contra-indications to application.

l. Increased sensitivity to UV rays.

2. Generalized dermatitis.

3. Toxic goiter, functional insufficiency of adrenal glands (in particular at Addison's disease).

3. Acute and chronic glomerulonephritis.

3. Chronic active and autoimmune hepatitis.

Dosage according to:

1) a biodoze (erythema or suberythema);

2) repetition factor of realization of procedures (at a local irradiation in 2-3 days on the same part of

skin, at a general irradiation daily);

2) quantity of procedures on a rate of treatment (at a local irradiation 3-4

influences on the same site of skin, at a genera irradiation up to 25).

In physiotherapy the biological method of dozing of UV rays estimating individual reaction of the man is

used. Unit of a doze is one biological doze (1 biodoze).

1 biodoze is minimal time of an irradiations expressed in minutes, which is enough for reception of

threshold erythema. Threshold erythema is weakest (minimal) erythema, but uniform and having precise border. For

definition of a biodoze is used biodosimeter of Gorbachev-Dolfeld, representing a plate with six rectangular apertures

(fig. 15). It is fixed on skin of a stomach on the left or on the inernal side of forearm. A source of UV rays, with which

help the medical procedures will be carried out subsequently, establish on distance 50 cm from a surface of skin, open

the first aperture and irradiate it within 0,5 minutes. Further with an interval of 0,5 minutes consistently open other five

apertures. Hence, skin of the first site is irradiated 3 minutes, second - 2,5 minutes, third -

1 minutes, fourth - 1,5 minutes, fifth - 1 minute and sixth - 0,5 minutes.

Other day (in 18-20 hours) estimate intensity of received erythema on

different sites of skin and choose threshold.

Fig. 15 Biodosimeter

We distinguish the following types of dozes: suberythema, that is not causing erythema of skin, and

erythema. Suberythema doze is a part of a biodoze, which is accepted for designating in simple fraction (from 1/8 up to

7/8 biodozes). Among erythema dozes allocate small or poorly - erythema (1-2 biodozes), average or erythema (3-4

biodozes), large or hypererythema (5-8 biodozes).

The general irradiation will be carried out usually suberythema dozes, and local - erythema. By erythema

dozes we irradiate during one procedure a site of skin, area isn't more than 800 sq cm or some sites of the same total

area.

3. Laser radiation.

The lasers are optical quantum generators. The name they have received from a combination of the first

letters of a phrase in English "Light amplification by stimulated emission of radiation” ("LASER"), that the

amplification of light is translated as "as a result of the compelled radiation".

Atoms, of which the various substances consist, in the elementary kind represent system consisting of a

nucleus and rotating around it electrones. In usual conditions this rotation occurs on constant, so-called basic

(stationary) orbits. Thus the atom has a minimum quantity of energy. The external influences can give to electrone the

additional energy allowing it to overcome an attraction of a nucleus and to proceed into more removed orbit. The atom

will proceed in the exited condition. But this condition is unstable. Through a very short interval of time (about 10~b

sec) electrone comes back to a former orbit, having allocated the absorbed energy as quantum of light (photon). Such

spontaneous transitions of electrone from one orbit to another are accidental, are independent from each other, occur in

different time. In usual conditions the number of the atoms which are taking place in an exited condition, is

insignificant, therefore energy of spontaneous radiation is insignificant. In a fig. 16 the circuit of the elementary optical

quantum generator (laser) is submitted.

Fig. 16 Circuits of the optical quantum generator: 1 - working body (active substance); 2 - system of

excitation ; 3 - power supply; 4-system of cooling; a 5-laser ray.

In lasers the main component is the working body, which represents by itself active environment or active

substance: various gases, liquids, firm bodies, semiconductors. The substances understand activity of environment or

their such condition, when the number of the atoms which are taking place in an exited condition, exceeds number of

atoms staying at the basic power level, that is in a quiet condition. In the exited condition a working body results more

often by influence of optical or electrical energy.

The following stage of process - transition of atom from exited to the basic condition. This transition can

occur not only spontaneously, but also under action of electromagnetic waves. Artificial influence by electromagnetic

irradiation upon working part allows making the process a controlled one. In this case according to the principle,

formulated by Einstein, the exited atoms irradiate photons with the same frequency, phase and in the same direction as

the electromagnet waves provoking this irradiation. Transitions of electrons under the influence of external irradiator

are called forced ones, and corresponding irradiation is also forced one. At presence of great amount of quanta of

external irradiation and great amount of exited atoms in the working part their transformation from exited to primary

state occurs and this leads to laser irradiation. In semiOconductor lasers occurs the direct transformation of electric

energy into laser irradiation that allows making the device quite small.

As distinct from other types of light flow laser irradiation is monochromatic, coherent (it means that phase of

waves of light coincide in space and time). High degree of coherence difines strict direction of laser irradiation, letting

to concentrate it at small area.

Lasers are classified according to the following physico-technical parameters:

1) Active substance (working body) - solid-state, gas-state, fluid, semi-conductive. In

physiotherapeutic devices most frequently are used helium-neon lasers and carbon dioxide lasers;

1) The length of wave of irradiation - UV range, visible range, IR range, multiple-tuned range;

1) Mode of irradiation - continuous, impact.

Devices:

- “Yagoda", laser physiotherapeutic plant (LPP). Helium-neon laser, mode of irradiation is continuous with

power up to 10mWt, length of wave is 0,63mkm;

"Raskos", helium-neon laser, mode of irradiation is continuous

with capacity up to 15mWT, length of wave is 0,633mkm;

"Galamed" is similar to "Raskos", but the capacity is up to 20 mWt;

"Uzor" is laser therapeutic device (LTD), arsenid-gallic laser, mode of irradiation is impact (80,

150, 300, 1500, 3000 Hz), capacity of impulse is up to 2 wt, length of wave is 0,89mkm (IR range). Nowadays there

are many types of devices are produced. There are also universal, which are made for use in physiotherapy and in

surgery, for example "Rasbor" LGM-2. Some devices are

completed by optical fibers for introduction into vein, for example LDBI (Laser device of blood irradiation). There are

devices for combined influence by laser irradiation and other physical phactors, for example MLTD (Magnet-infrared

laser therapeutic device) for treatment by constant magnet field, non-coherent light flow of IR sphere and laser impact

irradiation of IR range.

Irradiation is brought to tissues distantly or by contact. Different types of irradiators are grouped by prof. V.I.

Korepanov (1994) in the following way:

a) contact

a) contact with compression (compression provides greater depth of

penetration of irradiation)

a) contact-mirror (special reflectors help maximum absorption of

irradiation by tissues, it does not influence the staff)

a) intravascular

a) intraorganic (optical fiber is inside stomach, urinary bladder etc)

a) intracavitary (optical fiber is in pleural or abdominal cavity, cavity

of cyst, abscess etc);

a) extracorporal (distant irradiation of infusion medium, auto- and

donor blood).

The basical biophysical processes.

Thermal effect of laser irradiation is studied well enough. It has a lot in common with thermal effects of other

sources of light of visible and IR range, but thermal effect of laser irradiation has a number of specific peculiarities.

Different biological objects absorp irradiation of different length of wave. Laser irradiation is monochromatic, its

absorption is selective. IR irradiation of remote zone is absorbed first of all by water. Irradiation of visible sphere of

long wave about 7mlm is absorbed by pigmental formations, molecules of hemoglobin quite well. Irradiation of the

nearest IR zone warms up the membranes of the cells strongly. As a result of local warming of membranes there

appeares gradient of temperature in paramembrane areas that evokes thermodiffusion outflow of sodium and potassium

ions. As a result of it the canals of cellular membranes open up, the transport of ions and active molecules increases.

Changed electro-chemical ionic balance increases the energy of cell. At influence with impact laser irradiation the

formed warmth has no time to spread upon the neighbouring tissues and fluids. At great capacity of impulse the

momentary warming evokes a kind of explosion of elements of tissue.

Photochemical reactions are stimulated by visible and UV irradiation. Molecules turn into excited state as a

result of inner transformation of position of atoms. There is observed the change of membranous potential of cell,

charge of its electric field. Free radicals are formed in tissues intensively. Laser irradiation as distinct from usual light

provides selectivity of stimulation of biochemical compounds, having narrow stripes of absorption.

Mechanical action is peculiar to laser irradiation of high capacity in impact mode. As a result of direct

influence of impulse there appears blast wave in tissues. Its consequence is formation of sites of compression and

depression, spreading deep into tissues. There are different theoretical possible reasons of mechanical strain in tissues

may be considered: a) light pressure, the value of which is maximum, if the whole irradiation is absorbed at the surface

of tissue; b) pressure of feedback - emission of substance from a surface of irradiated object towards to a laser ray and

occurrence of a pulse of feedback working on a direction of a ray; c) electrosticking - redistribution of a charge in

dielectric, that conducts to occurrence of the mechanical rotating moment; d) sudden overheating of the irradiated site

of a tissue accompanied by its fast volumetric expansion, that results in occurrence of elastic fluctuations of a ultrasonic

range in boundary areas.

The basic physiological reactions and medical action.

The depth of penetration of laser radiation into tissues depends mainly on two factors; the spectral

characteristic of radiation and structure of tissues absorbing it. The same laws here are observed, as well as at influence

of a usual light flow of IR, seen and UV areas. In the whole penetrating ability of laser rays is estimated in 2-3 mm, but

the rays of nearest IR range with length of a wave from 0,8 up to 1,2 microns allow to influence depth 5-6 cm. The

share of the reflected radiation can make from 5 up to 40 %. In physiotherapy the radiation of nearest IR and red part of

visible range is used mainly.

The large capacities of laser radiation destroy tissues due to heating and mechanical action. They are used in

surgery: "laser scalpel ", designed in 1964. In physiotherapy the radiation of low power, so-called low intensity laser

radiation is used. Its influence on tisssue and organism as a whole in many respects reminds action of usual light of

appropriate length of a wave. But the special physical characteristics of laser radiation define a number of other laws of

its action, its higher activity. The basic reactions are observed in skin and superficial tissues. As a whole low intensity

laser radiation is stimulator of cellular activity nonspecific biostimulator of reparative and metabolism processes in

tissues. In cells enzymatic system is activated, the accumulation of DNA and glycogene is accelerated, the respiratory

activity of mitochondrion raises. The consumption of oxygen by tissues is increased. The stimulating action is

especially precisely shown in tissues which are taking place in a condition of reparative regeneration. At local

application can be observed antiinflammatory action of laser radiation. The formation of cellular shaft around of the

center of an inflammation due to stimulation of activity of neutrophils and macrophages, acceleration of prolypheration

of fibroblast is made active. Edema of tissues decreases and the broken microcirculation is normalized. The certain

meaning has bacteriostatic effect. The laser radiation influences on nervous receptors, changing their excitability and

rendering anesthetic effect. The effect of stimulation of regeneration of a nervous tissue is clearly shown. Alongside

with local changes of tissues the laser radiation stimulates non-specific protective systems of organism and adaptive

response by neuroreflex and humoral to mechanisms. Such stimulation is expressed at more extensive influences, rather

than local, punctated. The irritation of receptors of skin in area of reflexogenic zones changes character of impulses into

cerebral cortex and subcortical structures. In reply to it is formed regulating reaction from the side of the central

nervous system. At the same time hypothalamohypophysial suprarenal system and other endocrine glands are active.

Compensatory and adaptive reactions are directed to restoration of broken homeostasis. These effects depend on an

initial condition of this or that system that explains apparent universality of therapeutic action of laser radiation at

various diseases. The activation of system of immunity, desensibilizing effect, increase phagocytic activity of

neutrophils and macrophages is observed also. All taken together raises protective adaptive reaction of organism. Thus,

the influence of laser radiation at all levels of organization of living matter is established: subcellular, cellular, tissue,

organ, system and organism. This complex and multivariate action is investigated not completely.

The basic indications to application.

1. Lingering non- healing wounds, trophic ulcer.

2. Purulent - inflammatiry processes in soft tissues (at presence of a drainage): furuncules, phlegmones,

abscess.

3. Skin diseases: eczema, neurodermatitis, psoriasis, herpetic infection.

4. Infammatory, traumatic, metabolic-dystrophic diseases of musculoskeletal system, including fractures of

bones (for acceleration of consolidation), defeat of periarticular tissues and sinews.

5. Inflammatory diseases of mucous environments of a cavity of a nose,

gullet, mouth, including tonsillitis.

6. Diseases of peripheral nervous system, including the ones accompanied by pain.

7. Diseases of internal organs: stomach and duodenal ulcers, inflammatory defeats of bronchus lungs system,

essential hypertension (influence from the appropriate skin zones).

The basic contra-indications to application.

Specific contra-indications to application of cold laser radiation are not revealed. Look section "General

contra-indications to physiotherapy". Dosage according to:

1) density of a flow of capacity of radiation in mWt on 1 sq cm of the area (from 0,3 up to 10 mWt/sq cm);

2) duration of procedure (influence on one field about 5 minutes, on

some fields - total time of influence about 30 minutes);

2) On repetition of realization of procedures (daily);

2) By quantity of procedures on a rate of treatment (from 3 up to 15).

The note: at intravenous irradiation of blood capacity at an end face of light-carrying fiber up to 5 mWt, time of an

irradiation is about 30 minutes. The procedures daily or with breaks of some days are possible. Take into account that

the restoration of structure of endothelium after a 30-minute irradiation occurs in 6 hours.

Ultrasound therapy.

Ultrasound is a version of mechanical energy and represents mechanical fluctuations of elastic environment

by frequency more than 16 khz, which are not perceived by human ear. These fluctuations are transferred as

longitudinal waves, which cause alternate compression and rarefaction of environment or substance (fig. 17). The more

is capacity of transmitted energy, the bigger is the amplitude of deviations of particles of environment from an initial

condition. Distance including one area of compression and one area of rarefaction, makes length of a wave, which will

be back proportional to frequency of fluctuations.

The ultrasonic waves of low frequencies are distributed spherically. In process of increase of frequency of

fluctuations and, according to this, reduction of length of a wave, the beam of ultrasound waves becomes more

rectilinear. The straightforwardness of distribution of ultrasonic waves of high frequency (800 - 3000 khz) causes their

application in physiotherapy. These waves are distributed in parallel to each other, they can be concentrated on the

limited site. The law of distribution of high-frequency ultrasonic waves comes nearer to law of distribution of light:

absorption, refraction, reflection from border of two environments.

Absorption of ultrasonic waves in different tissues is various. For example, factor of absorption of ultrasound

for bone tissue is 12-15 times higher in comparison with muscular tissue. As a whole the higher is frequency of

fluctuations, the more intensive is absorption, the less is the depth of penetration. Ultrasound of high frequencies is

intensively absorbed by air. Its slightest layers between radiator and surface of a skin detain ultrasonic waves. In this

connection at medical influence use vacuum contact environments: liquid paraffin, glycerin, lanolin (fig. 18). When the

dense contact between oscillator of ultrasound and surface of a skin (area of hand, feet) is impossible, will carry out

remote influence through water with a backlash 1-2 cm.

Fig. 17 The graphic image of ultrasonic waves (condensation and rarefaction of particles of substance): 1 -

acoustic pressure; 2 - length of a wave; 3 - amplitude of a wave.

For reception of ultrasound the return piezoelectric effect is used. Piezoelectric effect is the phenomenon of

electrical polarization of crystals caused by their mechanical deformation: compression, stretching, bend, torsion. Such

properties have the crystals of quartz, barium titanate, Rochelle salt and others. On the other hand, at putting of these

crystals in a variable electrical field they are compressed and are stretched depending on a direction of a field. The

frequency of the received mechanical fluctuations corresponds to frequency of fluctuations of an electrical field. Thus,

the device for reception of ultrasound consists of the generator of high frequency and ultrasonic oscillator (vibrator,

applicator), in which the plate of quartz or barium titanate is placed.

Fig. 18 Circuits showing role of contact environment at influence by ultrasound: 1 - oscillator; 2 - skin; 3 -

air; 4 - contact environment.

Devices: - UZT (ultrasonic therapeutic), portable device. The model 1,01F radiates ultrasound by frequency

880 khz, model 3,01-g -2640Hz; -" of Ultrasound - T5 ", the portable device, radiates

Ultrasound by frequency 880 khz. The devices work in continuous and pulse modes, the frequency of pulses

50hz, pulses of various duration, which is expressed in milliseconds. The devices are completed by demountable

vibrators with a radiating surface 1 and 4 cm2. The special devices for treatment of stomatological, urological,

ophthalmological, ENT diseases and others are produced.

The basic biophysical processes in tissues are connected to three main effects of ultrasound: mechanical

(mechanicodynamic), physicochemical and thermal.

The mechanical action is shown at cellular and subcellular levels. The influence by ultrasound of the large

intensity results in break of tissue with formation of microscopic cavities, the time of which existence is

commensurable with the period of ultrasonic fluctuations.

This phenomenon is called cavitation (cavum-cavity), at application of therapeutic dozes is not observed. The

mechanical action of ultrasound of small intensity is used in physiotherapy, consists in vibrating micromassage of

tissues. Thus in cells and tissue structures the processes of diffusion and osmosis amplify.

The physicochemical activity of ultrasound is connected to the complex electronic-quantum phenomena at a

molecular level. The movement of molecules is accelerated, the formation of ions amplifies. In tissues the quantity of

free radicals is increased, the formation of biologically active substances and oxidation-redaction reaction is activated,

raises dispersity of colloids of cells. In therapeutic dozes of ultrasound is the catalyst of biochemical reactions. The

electronic-quantum phenomena sharply increase their own chemoluminescence of blood. At application of large

intensity of ultrasound (in dozes exceeding therapeutic ones many times) is possible to observe decolouration of

organic dyes, oxidation of potassium iodide that also confirms the presence of physico-chemical effect.

The thermal effect is connected to transformation of mechanical energy into thermal; here we talk about

endogenous heat. Heat is allocated first of all in tissues intensively absorbing ultrasound: a nervous tissue, bones. There

happens heating of all tissues – volumetric heating, the heat is also evolved on border of two environments of different

acoustic density - structural heating. As in physiotherapy the ultrasound of law intensity is used, the noticeable increase

of temperature of a tissue during procedure is not observed. The thermal effect in this case plays a supporting role.

The basic physiological reactions and medical action. Depending on a used doze it is possible to observe

damaging, oppressing and stimulating action of ultrasound. In physiotherapy we use dozes, which cause stimulating

effect, do not cause destructive changes in tissues. It is necessary to take into account, that the dozes ensuring

stimulating action, are very close to dozes causing an oppression of function. It is easy to overdose the medical

procedure.

The depth of penetration into tissue of ultrasound by frequency 800-1000 kHz is estimated in 5-6cm, by

frequency 2400 kHz is three times less. Best of all the ultrasound will penetrate into a fatty tissue, lingers over mascular

and nervous ones. The significant quantity of ultrasound is absorbed on border of tissues with various acoustic density.

60 % of energy of ultrasound, falling on bones is reflected. In small, subthreshold dozes of ultrasound can penetrate on

depth up to 20 cm, to what the given visualization of the waves, reflected from this depth testify. This fact is used in

ultrasonic diagnostics. The physiological answer-back reactions connected to the basic biophysical effects are closely

bound and cooperate. In therapeutic dozes ultrasound renders in the whole stimulating influence on function of cells. In

an initial phase of influence is observed swelling of mitochondria, deviation in structure of matrix, and the structure of

cellular form becomes degraded. The irritation of a cell results in activation of its ability to live, amplification of

respiratory activity of mitochondria. As a whole the effect biological stimulation is observed which keeps within

several hours after unitary influence. Higher dozes cause sudden changes of cellular microstructures, suppress activity

of a cell, there are attributes of damaging action.

At influence by ultrasound on a connecting tissue rejuvenation of its cellular and fibrous structures is

observed. There are cells with plentifully submitted protoplasm, in the basic substance the quantity of elastic fibers

grows and collagen formation is oppressed. At influence on superfluous connecting tissues with the changed structure

of ultrasound renders scatting action that makes the scar more elastic. Ultrasound of small intensities accelerates

regeneration of the damaged nervous fiber, reduces sensitivity of receptors that is shown by anesthetic action.

Ultrasound works on receptor system of skin, not causing appreciable subjective sensations. The skin of the person and

stomach is most sensitive to its influence. The influence on skin receptors of definite reflexogenic zones results in

general answer-back reactions, which are realized through high vegetative centers, hypothalamic-pituitary system.

According to this mechanism of action the ultrasonic therapy raises lability of the nervous centers and adaptation-

trophic function of the entire organism. In some medical procedures this general action of ultrasound is used.

The basic indications to application.

1. Commissural and cicatricial processes (burning injury, perivisceral complication, stomach ulcer,

inflammatory diseases of female sexual sphere).

2. Degenerative-dystrophic disease of joints of extremities and backbone.

3. Inflammatory diseases and traumatic defeat of the musculoskeletal system defeat of para-articular tissues.

4. Inflammatory diseases of ENT-organs, female and man's sexual spheres.

5. Disease of peripheral nervous system, including defeats of facial and trigeminus.

6. Stomach ulcer and doudenal ulcer, bronchial asthma (influence of appropriate reflexogenic zones).

The basic contra-indications to application.

1. Sharply expressed functional frustration of the central nervous system.

2. Thrombophlebitis (in a zone of influence).

3. Infringement of a rhythm of heart.

3. Influence on area of large vessels, cerebrum, displayed bone surfaces.

Dosage according to: 1) intensity of influence (from 0,05 up to 1,2 wt/cm2);

2) mode of influence (continuous or impact);

2) duration of procedure (from 2 about 6 minutes upon one part, at

influence on several parts total time is about 15 minutes);

2) area of irradiation (one field is not more than 250 sq. cm, per

the first day no more than two fields, the next days - up to five fields);

2) repetition factor of realization of procedures (daily or every

other day);

2) quantity of procedures on a rate of treatment (from 6 up to 14).

Phonophoresis is a combined influence of ultrasonic waves and medicinal substance on tissues. Under

influence of ultrasound raises adsorptive ability of a skin, through cells and intercellular space begin to penetrate

particles of medicinal substance in quantities, sufficient for rendering of medical action. The depth of penetration is

limited actually by skin, in which medicine is deposited. The quantity of medicinal substance received by organism at

phonophoresis makes from 1 up to 5% its quantity used at realization of procedure. Engineering of procedure of

phonophoresis is the same, as at usual procedures of ultrasonic therapy, but on contact environment the medicine is

added. The orientation of action of medicinal substance should coincide with an orientation of action of ultrasound. The

medicinal substance thus should not lose the pharmacological activity. Is most distributed is phonophoresis of

glucocorticoid (usually hydrocortisone) and nonsteroidal antiinflammatory preparations at diseases of joints and para-

articular tissues.

The procedures daily or with breaks of some days are possible. Take into account that the restoration of

structure of endothelium after a 30-minute irradiation occurs in 6 hours.

Thermotherapy

Thermotherapy - application with the medical purposes of the heated up bodies named as heat-carriers. The

heating of tissues occurs at direct contact to the heat-carrier.

Thermotherapy is one of the oldest and most widespread methods of physiotherapy. It was applied before and

the plenty of various heat-carriers offered as by folk, and official medicine is applied now. The thermal influences

cause change of metabolism. At increase of temperature of a tissue for 1C the intensity of exchange processes in it

grows approximately by 10 %. For achievement of medical effect it is enough to increase temperature of a tissue for 4-

5 C, but the heating should be long enough, and thermal flow uniform and stable. In this connection the heat-carrier

should have the certain physical properties, due to which such heating is provided.

The preference should be given back to heat-carriers having large thermal capacity. Thermal capacity is a

quantity of heat expressed in small calories, which is required for increase of temperature of 1 g of substance for 1 C.

The more is the thermal capacity of the heat-carrier, the more warmth is transferred to tissues. Other important

characteristic of the heat-carrier is thermal capacity, on which the ability of substance depends to transfer heat. At

contact with the heat-carrier in a tissue the thermal flow is directed, which intensity is measured by quantity of heat

which is taking place for a time unit through a unit of surface. The more is the thermal capacity of the heat-carrier, the

more intensive is the thermal flow. As for reception of medical effect the large heating of a tissue is not required, the

heat-carriers with small thermal capacity are more preferable which provides a thermal flow of small intensity. With

thermal capacity the heat-retaining ability of the heated up body is closely connected. The less is the thermal capacity,

the longer time the heat-carrier remains heated up, the longer time a thermal flow takes. The important meaning in

processes of heat emission has convection-mixing of cold and warm layers of the heated up substance or environment.

Heat emission of water, for example, is provided mainly by convection. In heat-carriers used in physiotherapy,

convectional flows are insignificant or practically are absent. At contact of such heat-carrier to tissues its thin layer,

directly adjacent to skin, is quickly cooled. Basic weight of the heat-carrier gives back heat through this cooled layer by

means of thermal conductivity. As the heat-carrier has small thermal conductivity, the patient easily transfers high

enough temperature of heat-carrier.

Hence, as heat-carriers first of all are used substances having large thermal capacity and small thermal

conductivity in which convection is minimal or absent.

The basic physiological reactions and medical action of heat, basic indications and contra-indications to its

application were discussed in the previous chapters. We remind of the following main effects of heat: antispastic,

anodyne, intensifying blood- and lymph circulation and metabolism in tissues. To last effect is connected absoptive and

regenerative action of heat, in particular at inflammatory processes.

The heat-carriers apply mainly as local influences - applications. The procedure is dozed according to

temperature of the heat-carrier and duration of influence (30 - 60 minutes). The procedures are carried out daily or

every other day, in quantity from 12 up to 20 on a rate of treatment.

The basic indications to thermotherapeutic procedures:

1. Inflammatory processes (without suppuration) in a stage of the resolution

1. Degenerative-dystrophic and inflammatory disease of the musculosceletal system.

1. Disease and trauma of peripheral nervous system.

1. Consequence of traumas with the purpose of analgesia(bruises, stretching of ligaments).

1. Hypermotor dyskinesia of internal organs.

1. Contracture of muscles of spastic type (before medical gymnastics).

The basic contra-indications to thermotherapy.

1. Acute and subacute stage of inflammatory process, purulent inflammation, aggravation of chronic

diseases.

1. Infringement of thermal sensitivity of skin.

1. Medical application of paraffin and ozokerite.

Paraffin (parumal This - ineffective, Lat.) is the mix of firm high-molecular hydrocarbon of methanoic line,

has a microcrystal structure. Paraffin is received by special processing of some grades of petroleum. Depending on a

degree of clearing of paraffin, the contents in it of petroleum oils distinguish high-purity, cleared and crude grades. In

physiotherpy we use high-purity and cleared paraffins representing mass of white colour.

The melting point of different grades of paraffin changes over a wide range. In medicine high-melting

paraffins are used, which melting point is 52-55 C.

The paraffin has high heat capacity, very small heat conductivity and practically is deprived of convection. In

medical effect its special meaning has latent heat of melting - quantity of heat spent on transformation of paraffin from

a solid condition into liquid one. At back transformation from a liquid condition into solid the latent heat of the

hardening equals to latent heat of melting. During this transition temperature of weight of paraffin used for application,

remains constant that provides a stable thermal flow for long enough time (fig. 19).

At heating of paraffin before medical procedure its temperature is brought up to 95 C. For this purpose

special paraffin-heaters with electric heaters are used, which works by a principle of water-bath.

Fig. 19 Curves of cooling 75 g of substance at temperature of air 18 C: 1 - paraffin; 2 - water. The following

techniques of paraffinotherapy are applied.

1. Cuvette applicable method: enameled vat is used, which size corresponds to the area of imposing of

paraffin. In laid out by a medical oil-cloth vat we pour melted paraffin by a layer of thickness 1-2 cm. Stiffened, but

still soft paraffin take out from vat together with an oil cloth, impose on a site of a bodies subject to influence, and

cover with quilted jacket or blanket. This method is most simple on engineering of performance, can be used in home

conditions. It is possible to transfer the vat to chamber and to carry out procedure outside of a heat-therapy

room.

2. Napkin-applicable method: melted paraffin we put on a surface of a skin by a brush up to thickness of a

layer 0,5 cm. On this layer impose a napkin made of 8-10 layers of a gauze, and moistened in melted paraffin. A napkin

cover with an oil-cloth, then with blanket.

3. Method of lay-up: melted paraffin put on a surface of a skin by a brush up to thickness of a layer 1-2 cm,

cover with an oil-cloth, then with blanket

4. Method of a paraffin bath: are used for influence on a hand or foot, which cover with paraffin by a

method of lay-up. Then a hand or foot immerse into melted paraffin which has been heated up till 60-65 C, with which

is filled special tub or oil-cloth bag.

At paraffinotherapy it is necessary to watch, that skin influenced by paraffin should be absolutely dry in

avoidance of a burn. The hair should be shaved or appropriate site of a skin to grease with vaseline, so that they did not

stick to the cooled down paraffin.

At melting the paraffin mass is increased in volume on 10-15%. At hardening volume of paraffin accordingly

decreases. In case of use circular application of paraffin compression of tissues is significant. At compression a lot of

heat is transferred, at the same time this heat to a lesser degree is transferred by blood to other organs and tissues. The

same paraffin can be used for heat therapy several times. Before a reuse paraffin should be sterilized by heating it up to

110 C. Then heating is stopped.

The decrease of temperature of paraffin up to 100 C in usual room conditions takes time, sufficient for its

sterilization. For preservation of elastic properties of reusable paraffin it is necessary to add 15-20 % of a fresh one to

it. Such procedure is possible to repeat 3-4 times. After that the paraffin loses the elasticity, crumbles at cooling and

further use is not possible.

Ozokerite (ozo-to smell, heros-wax, Greek.)," smelling by wax ", mountain wax. It is a product of a

petroleum origin, consists mainly of a mix of solid high-melting hydrocarbons of a paraffin series with a touch of liquid

and gaseous hydrocarbons of the same series. Ozokerite is natural rock. Its various deposits differ by chemical structure

they are various in color: light green, yellow, brown, black. At a long storage on air ozokerite darkens.

Ozokerite is received, evaporating rock in boiler or extracting by its organic compounds. Then partial

distillation of mineral oils is made, completely release it from water, mechanical admixtures. After processing ozokerite

reminds beeswax.

Melting point of ozokerite is from 52 up to 68 C. Its heat is higher, and heat conductivity is lower, than the

one of the paraffin. Heat retaining ability is much higher than the one of the paraffin, convection of heat is practically

absent.

Medical action of ozokerite is connected not only to its features as heat-carrier, but also with presence in its

structure of the biologically active substances penetrating through an intact skin. They render acetylcholine-like action,

raising tone of parasympathetic department of vegetative nervous system. There are items of information about more

active regeneration of peripheral nerves at their diseases and traumas at treatment by ozokerite in comparison with

paraffin. It is mentioned about presence of ozokerite in folliculin-like substances, in this connection its application is

recommended at treatment of female sterility, connected with underdevelopment of ovaries.

In the whole technique of treatment with ozokerite, indication and contra-indication to its application are the

same, as at paraffin-therapy.

2. Mud cure

Therapeutic muds or peloids (pelos - silt, clay, Greek.) represent natural formations consisting of water,

mineral and organic substances having fine-dispersed structure and pasty consistence. On an origin they are subdivided

into six types.

1. Silt sulphide muds - silt sediments of salty reservoirs.

1. Sapropels - silt sediments of stale reservoirs.

1. Peat muds - peat formations of bogs.

1. Clay silts - mineralized deposits of reservoirs with the small contents of organic substances and absence

of ferrum sulfides.

1. Mound muds - semi-fluid clay formations arising at destruction of mountain breeds, disposable in gas-

petroliferous areas.

1. Hydrothermal muds - semi-fluid clay formations arising in areas of active volcanic activity.

Most widespread, investigated and used with the medical purposes are first three types of muds: silt, sapropels

and peat. In each type of a medical mud three components are distinguished: a crystal skeleton, colloid fraction and

mud solution.

Crystal skeleton - inorganic coarsely dispersed part of mud. It consists of smallest particles of sand, clay,

phosphates and calcium and magnesium carbonates, insoluble in water. There can be a small quantity of the remains of

a vegetative and animal origin. A diameter of particles is not more than 0,25 mm. The large part of a crystal skeleton in

a medical mud gives to it granularity, friability, reduction of plasticity, which sometimes is required to be increased by

addition of water.

Colloid fraction is a fine part of mud, which connects separate parts of a crystal skeleton and fills in all its

intervals. It consists of complex inorganic and organo-mineral, organic substances. The important part of it makes

colloid ferrum hydrosulfide. Here are available also ferrous hydroxides,aluminium hydroxides, silicon acid and other

compounds. Organic colloids are products of disintegration of plants and animals, which main part consists of humic

substances, nitrous compounds,organic acids. The important medical meaning have such substances of an organic

origin, as antibiotics, biogenic stimulants, enzyme-like and hormone-like compounds. Colloid fraction defines plasticity

of mud, its dense adjacency, bad wiping off by water. The physical properties of mud as heat-carrier depend on it.

Mud solution - liquid part of mud consisting of water, mineral salts, dissolved in it, organic substances, gases.

It contains first of all sodium, magnesium chloride and phosphate, magnesium sulphate, hydrogen sulfide, methane,

carbonic gas. Here there are microelements -iron, zinc, cobalt. The part of mud solution in a medical mud depends on

the contents of colloids in it, possessing hydrophilic properties. Mud solution basically corresponds to chemical

structure of brine - layer of water covering mud sediments. But the structure of brine can vary, while the structure of

mud solution differs by the large constancy. The soluble biologically active substances are not only in colloid fraction,

but also in mud solution. The separate elements of mud solution, extracted from a medical mud, are applied as

injections as biogenic stimulants: FiBS, peloidodistillate (products of estuary muds), humisole (solution of fractions of

humine acids of sea muds), torphot (solvent stripper of a peat mud).

In destruction and processing of dead plants and animals participating in formation of a medical mud, the

main role plays microflora. The microorganisms make from 2 up to 6 % of organic mass of mud. Here there are septic

aerobes and anaerobes,damaging cellular tissue, sulphate-reducing and butyric bacterium, various kinds of fungi. The

large meaning have sulphate-reducing bacteria forming hydrogen sulphide. Hydrogen sulphide combines with iron,

forming hydrotroilite, being one of the main components of silt sulphide mud.The pathogenic for man microflora in

medical mud is absent. Microflora participates in regeneration of mud, that is in restoration of its physico-chemical,

microbiological and sanitary - biological parameters after medical use.

At storage in the certain conditions any type of mud is capable to regeneration, only the terms of this process

are different. For example, silt sulphide mud recycles within 3-4 months, and then it can be used again.

Silt sulphide muds are formed at the bottom of open salty reservoirs, where there is no intensive excitement

and currents. Depending on a site of such reservoir allocate continental (for example, lake Tambukan in Stavropol

Territory), lake-spring, formed in reservoirs, which are fed be mineralized underground waters (lake of a Thermal

resort Sergiyevskiye Mineral Waters in the Samara area), seaside (lake Sakskoye in a steppe zone of Crimea), sea

(ground sediment in sea gulfs, bays, estuary).

The natural evaporation of water results in accumulation of inorganic salts in brine and mud solution. The

quantity of organic substances in this mud is insignificant, as bioweight of these reservoirs is rather insignificant. Silt

mud is rich by ferrum sulphide giving to it dark coloring. It has a weak smell of hydrogen sulphide and ammonia. Mud

possesses plasticity due to significant quantity of colloids.

Sapropelic muds (sapros - rotten, pelos - silt, clay, Greek.) are formed at the bottom of open stale reservoirs

due to decomposition of lowest animals and vegetative organisms. Due to it sapropels contain a plenty of organic

colloids, having good hydrophily. In this connection they differ from other muds by the large contents of mud solution,

having a liquid consistence, that sometimes require their upholding before the use. As in sapropels the contents of

organic substances is great, the significant quantity of biologically active components in them is formed.

The peat muds are formed in overgrown reservoirs (bogs) at decomposition of maximum plants in

conditions of superfluous humidifying and difficulty of access of oxygen. The structure of a peat mud depends on

character of a water mode and plants - peat-makers. The type of a peat muds depends on a degree of mineralization of a

mud solution, contents of sulphides.Sulphidless freshwater peat is met more often. The most rare type - mineralized

strong-acid peat, which contains significant quantity of salts of iron and sulfuric acid, has astringent and cauterizing

effect. One of deposits of such peat is in the area of Sapozhok of Ryazan region. In a peat mud there is a lot of crystal

fraction and a little of colloid one, therefore it differs by friability and granularity. Peats contain a plenty of organic

substances, among which the important meaning have humic substances having high biological activity.

The mechanism of action of mud-therapy procedures .

The action of medical muds on organism of the man develops of the thermal and chemical factors. At

application of general mud baths the mechanical factor here is added. Mud-therapy procedure causes local and general

reactions.

Therapeutic value of medical mud as heat-carriers is caused by their high heat capacity, little heat

conductivity and almost completes absence of convection. These properties allow using mud of concerning high

temperature.

However it is established, that the temperatures at a level 38-40C causes the most favorable changes in

organism.

The special role in medical action of muds belongs to chemical and biologically active substances. They will

penetrate through the intact skin, rendering local and general action. The permeability of a skin is increased at

application of the heated up mud.

The medical mud due to adsorption properties clears skin, absorbing products of metabolism and bacteria. It

promotes increase adsorption and excretion function of skin. The local skin reactions morphologically are characterized

by proliferation of Malpighian and thickening of cornean layers, increase of quantity of fibroblasts, formation of

fibrous tissue. In a skin the quantity of histiocytes, lymphocytes are increased. Excitability of skin receptors after short-

term increase is considerably reduced. The degree of intensity of the specified changes is various at use of various types

of a medical mud. For example, acidic Sopozhok's peat causes more significant reactions in comparison with

alcalescent silt tambukan mud.

The general action is realized on nervous - reflex and humoral mechanisms. The chemical and thermal

irritation of receptors of a skin causes answer-back reactions both in a zone of the appropriate segment, and in other

parts of a body, in the central nervous system due to irradiation of excitation. The inclusion of hypothalamus in sphere

of influence of mud-therapy procedure activates hormonal a part of reflex-humoral system. Neurohormons, developed

by hypothalamus, stimulate activity of hypophysis, and hormones of hypophysis activate adrenal cortex and other

endocrine glands.

The chemical and biologically active substances, being soaked up through skin, get in bloodflow, rendering

general action. Their influence is especially appreciable at inflammatory processes. The activation of cellular reactions,

stimulaton of activity of fibroblasts promotes restoration of tissues damaged by an inflammation. Braking processes of

free - radical oxidation is observed. In this connection after possible aggravation anti-inflammatory effect is observed.

The application of mud-therapy in a stage of fading of inflammatory process is most expedient and during restoration

of tissues. The action mud applications is favorable at distrophyc processes, where more or less active phases are

observed.

Hence, mud-therapy procedures render anti-inflammatory, resolving, regenerative, analgetic action. They

strengthen effect of antiinflammatory medicines.

The reaction of the organism on mud-therapeutic procedure depends on its functional condition. At treatment of the

same disease the positive effect can be received from the different patients, applying various types of medical muds.

The question of a choice of mud and optimum of its dosage for the various forms of diseases remains urgent.

Methods and techniques of mud-therapeutic procedures.

Before the use a medical mud should be heated up on water or steam bath. On a couch display cloth or

blanket, on which put a medical oil-cloth, and on it linen sheet. On a sheet impose mud mass of given temperature. The

patient lays down on a mud mass. A site, subject to influence, of a body is covered by mud also wrap up by the

specified layers of tissues. During procedure the medical sister observes of the patient, supervises pulse and breath.

After termination of procedure the patient is unwrapped, by palms remove from a body the mud and he is washed under

raining douche of temperatures 36-37 C without use of a soap and bast whisp. Dried himself and having put on the

clothes, the patient has a rest in a special room 30-40min.

Duration of procedure 15-20 minutes, less often - 30 minutes. They will be carried out daily, or every other

day, two days in succession with rest for the third day. The rate of treatment consists of 12-18 procedures.

Mud applications can be general and local. General applications are now applied seldom, they can be shown

at the very much widespread processes. In this case mud is imposed on the whole body except for a head and area of

heart by a layer of thickness 2-3 cm.

Local applications are put on definite part of a body: area of hands - "gloves", feet and shins - "socks", pelvis

and upper part of hips -"pants", pelvis and legs - "trousers", pelvis and one leg -"semitrousers", chest and arms -

"jacket", half of chest and one arm - "semijacket"; on the area of abdomen or projections of its organs -stomach, liver,

intestine; neck-collar area.

There are the following methods of influence on the definite part of body:

local (focal), when application is made on the area of injure

parafocal, when application is made beside the center of injure to avoid the pathological process

segment-reflex, in this case application is made on area of projection of the corresponding spinal segment, the

example may be influence on neck-collar area at

encephalitis, arachnoiditis;

repercussion influence with account on metameric reflex, including reflected changes in the area of one segment

from the opposite side.For example in case of pathologic process on the right extremity the mud application is made on

the left one;

combined influence on the area of pathological center and segment-reflex zone. For example at influence on the

stomach the mud applications are put on epigastric area and back in the area of 7-10 thoracic vertebra.

In case of local applications the thickness of mud layer is 4-6cm for silt mud and 6-8cm for peat mud. Also

intracavitary mud therapy is used in form of vaginal and rectal mud tampons. In this case the mud is cleaned from

mechanic admixtures by rubbing through sieve or gauze.

The main indications and contra-indications to mud therapy are the same as to use of the other heat

procedures. Effectiveness of mud therapy is connected with combined and correlation influence on the organism of

heat and chemical factor.

In some cases the influence of chemical and biologically active substances prevails. This peculiarity singles out the

medical muds from the number of other heat-carriers. Mud therapy traditionally concidered a type of heat therapy, but

actually it is a special type of physiotherapy. To the usual indications for mud therapy as for the other ones it is

necessary to add some other:

diseases and consequences of traumas of central nervous system (consequences of wouns and contusions, residual

phenomena of encephalitis, myelitis, arachnoiditis, polyomyelitis,disseminated sclerosis). Influence upon neck-collar

area;

causalgia - pains in extremities as results of wounds;

vibrating disease. Indication of mud "gloves", "collars"

sclerodermatitis in unactive phase;

diseases of organs of digestion in acute and subacute stages: gastric

and duodenal ulcer, chronic gastritis, chronic cholitis, chronic cholecystitis etc.;

chronic nonspecific bronchopulmonary diseases;

diseases of female and male sex sphere

urologic diseases.

Hydropathy

Under hydropathy is understood the use of water in medical preventive and rehabilitation purposes with the

help of the specially developed methods. Hydropathy includes hydrotherapy, essential hydropathy -procedure with use

of sweet water, and balneotherapy (balneum bathing, bath, Lat.) - procedure with use of mineral water.

I. Hydrotherapy

The hydrotherapy is an outside application of fresh water as baths, showers, dousings, rubdowns, wrappings. The

influence can be general or local. In the specified procedures on organism influence thermal and mechanical irritants.

For amplification of external action of fresh water the various substances can be added to it: a coniferous extract,

condensate of muskat sage, mustard, turpentine etc. The thermal factor in hydrotherapy is basic. It is shown the more

strongly, the more is difference of temperatures of water and surface of a body. Depending on temperature distinguish

the following kinds of hydropathic procedures:

Cold (is lower 20 C);

Cool (20 -33 C);

Indifferent (34 - 37 C);

Warm (38-39 C);

Hot (40 C and higher).

Especially powerful influence has the contrast water procedures -alternate influence by water of high and low

temperature.

A little bit different ranges of temperatures determining a kind of hydropathic procedure can be specified in manuals

and directories on physiotherapy. For example, to hot water procedure sometimes carry influence of temperature 38 C

and more. Sometimes the same author of a bath of temperature 35 C names both indifferent and warm. The temperature

gradation of baths and showers differ a little. For example the bath of indifferent temperature 34 - 37 C, indifferent

shower -35-37 C.

Water is characterized by high thermal capacity, exceeding those of paraffin, ozokerite and therapeutic muds. It has

good heat conductivity, it exceeds heat conductivity of air 30 times, it also has high convection ability. Water is natural

biological irritant, which the man meets constantly in the daily life.

The cold water procedures show the large requirements to central regulatory mechanisms, create significant loading on

cardiovascular system. Even to the healthy people in the beginning are indicated indifferent or cool influences, and

then, gradually reducing temperature of water, pass to cold. The first phase of reaction on cold water - spasm of vessels

of skin. In reply to cold irritation of skin receptors metabolism in internal tissues is accelerated, first of all in muscles

and liver. Temperature of these tissues raises. The second phase of reaction is shown hyperemia of skin due to

impulsing from thermoreceptors of internal bodies. This reaction is accompanied by sensation of heat and vivacity, it

should achieve at every hydropathic procedure. The third phase of reaction comes at too long or very strong cold

irritation. In this phase occurs passive hyperemia of skin. The skin gets cyanotic discoloration as a result of delay of

bloodflow in it, tremor of muscles occurs. Such reaction shows an excessive irritation and it cannot be supposed at

hydropathy. The cold water procedures decrease number of heart beats also increase their force, raise arterial pressure.

The breath in the beginning of procedures lingers over, then becomes frequent and further is slowed down, goes deep.

Tone of skeletal and smooth muscles is increased. Cold, as well as the cool water procedures, render general

stimulating action, raise reactivity and adaptive abilities of the organism

The hot water procedures at the first moment cause spasm of vessels of skin, then very quickly there comes their

expansion. Internal temperature of a body raises, the exchange of substances becomes more intensive. The hot water

procedures increase frequency of heart beats, reduce their force, reduce arterial pressure, the breath becomes frequent,

and the depth of respiratory movements decreases. Tone of skeletal and smooth muscles is reduced. The hot water

procedures at short-term influence stimulate nervous system, and at long - cause its exhaustion.

Indifferent and the warm water procedures cause light hyperemia of skin, evoke a feeling of calm, the general state of

health is improved. As a whole they render braking action on nervous system, causing sedative effect. It is necessary to

take into account, that the sensation of comfort depends not only on temperature of water, but also on adaptive

opportunities of thermoregulatory mechanisms, degree of stability of organism to thermal irritants. Partly it explains

distinctions in a range of indifferent temperatures brought by the various authors. The repeated procedures with

application of indifferent and warm water work as monotonous and not intensive irritant, causing diffuse inhibition in

cerebral cortex. Mechanisms of thermoregulation, nervous and cardiovascular systems as though have a rest. In

subsequent their serviceability is increased. Last decades in hydropathy prefer softly working procedures, which cause

more favorable answer-back reactions. Hence, most frequently are applied indifferent and warm water procedures.

They render more expressed training action on regulatory systems of the organism, promote restoration of adaptive

mechanisms. But it does not exclude an opportunity of use of cold, hot and contrast temperatures at the appropriate

functional condition of organism. They are recommended to those persons, whom it is necessary to increase mobility of

protective mechanisms, considerably to change reactivity.

The mechanical factor in hydrotherapy influences alongside with thermal in any procedure. Receptor system of skin is

generated in conditions of air environment. In result of inhibition of skin by fresh water and the pressure of its weight

occur quantitative and qualitative changes of physiological reactions on an irritation. The mechanical action is realized

through mechanoreceptors, supplementing action of the thermal factor.

1. Bath

Baths are hydropathic procedures, at which the body of the man is completely or partially immersed in water of given

temperature. Depending on volume of the shipped part of a body distinguish general and local baths.

General baths. The patient is in a bath reclining. A head, neck and top part of a breast remain open. The procedures will

carry out daily, or two days in succession with a break for the third day. On a rate of treatment 15-20 baths are required.

Duration of baths of warm and indifferent temperature from 8 about 15 minutes. The cold and hot baths are applied

much less often, duration them from 1 about 4 minutes. For contrast temperature influences two small adjacent pools

(fig. 20) are used, in which the patient can move. The movements are obligatory in pool with cold water. On special

stairs the patient passes from one pool in another. The procedure begins with immersing of the patient in hot water for

2-3 minutes, and then - in cold for 1 minute. The transitions from one pool in another repeat from 3 up to 6 times. If the

tonic action is required, procedure finish by a cold bath, if the action should be calming - hot. After procedure the

patient is carefully pounded. The baths of gradually raised temperature from 37 till 40-42 C which is a strong thermal

irritant are also used but in our country very seldom. The rate of treatment by such baths consists of 6 - 10 procedures,

duration by each of which about 20 minutes.

Fig. 20 Schematic images of a general view of contrast baths:

1 - bath for hot water; 2 - bath for cold water; 3 - disinfectant solution for legs.

The mechanical factor in a general bath is submitted by pressure of a pole of water, component about 0,05 atm. For

exception of action of mechanical pressure use foamy baths. For their preparation on bottom pour small amount of hot

water and add foam maker, usually it is a special soap liquid or soap powder. By any mechanical way the formations of

foam is achieved. That the body of the patient did not adjoin to water at the bottom baths, he lies down on a wooden

lattice.

Temperature of foam is usually 8-10 lower than temperature of water which is taking place at the bottom of a bath. The

foamy baths apply when it is necessary to limit influence on cardiovascular system. Duration of procedure is about 20

minutes. The mechanical action can be strengthened, creating in a bath movement of water - vortical and vibrating

baths. In vertical baths the various technical ways create monotonous movement of water. In vibrating baths the

vibrating water waves with the help of the device "Volna-G", forming fluctuation by frequency 50 or 100 hz are

created, and device "Volna - 2 ", forming fluctuation, which frequency can vary in a range from 10 up to 200hz. With

the help of nozzles the vibration are directed on the certain site of a body. Is revealed expressed analgetic action of such

baths first of all at radiculitis and polyateritis. In both types of baths, vortical and vibrating essential is strict dozing of a

mechanical component, as overdoze results in increase of pains.

Temperature of water is usual from 35 up to 38 C, the rate of treatment is limited to 10-15 procedures at their usual

duration and periodicity (daily 8-15 minutes).

Local baths. At their use influence any part of a body: a hand or both hands, leg or both legs, all extremities (four-

chamber baths), basin. The sedentary baths will be carried out in special capacities. The bottom part of a stomach, basin

and top part of hips is immersed in water. Feet of the patient lower into basin with warm water. Semibaths is

conditionally possible also to attribute to local baths, though frequently they are considered as a separate version of

hydropathic procedure. The patient sits in a bath, the level of water in which reaches his navel. This procedure is

usually combined with dousing and grinding.

The local baths can be applied, using gradually raising temperature (for example, bath according to Gayffe). To carry

out simultaneously vertical and vibrating influences with the help of the same equipment, as in general baths.

3. Showers

Shower is hydropathic procedure, at which a surface of a body is influenced by a jet or many jets of water of dozed

pressure and temperature. The bringing of water to installations of medical showers is carried out with the help of

shower (hydropathic) platform (fig. 21). The board of its management allows adjusting temperature and pressure of

water.

Fig. 21 Shower (hydropathic) platform.

As well as baths, the showers of warm and indifferent temperature render general calming action. The showers of cold

and hot at short-term procedure work generally tonic at long procedure reduce excitability of the impellent and

sensitive nervous endings. Raise intensity of an exchange of substances in tissues. After cool and cold showers the

grinding by a rough towel will be carried out. The physiological action of showers is appreciably caused by force of a

mechanical irritation. Distinguish showers with low pressure of water from 0.3 up to 1 atm.. Average - from 1,5 up to 2

atm. And high - from 3 up to 4 atm. On growing intensity of mechanical influence showers are settled down in the

following order: dispersive douche,raining douche, needle-bath, fan douche, circular douche, stream douche.

Dispersive douche: on a surface of a body the drops, broken up to a fine water dust influence. For reception of such

shower we use a tip as a sphere, from which four depart under a direct corner bent tube, apertures, having on the ends,

of a small diameter (fig. 22). These apertures are left by water as a water dust falling freely (without creation of

additional pressure) on the patient. The mechanical action it soul is minimal.

Fig. 22 Tip for dispersive douche.

Raining douche: water leaves numerous apertures of a special grid located at height 2 meters from a floor (fig. 23). The

fine jets of water (rain) by force of own weight influence a surface of a body.

Fig. 23 Raining douche.

Needle-bath we receive with the help of a grid similar to a grid of raining shower, but into every aperture of a grid is

screwed a metal tube with a narrowed gleam, which target diameter 0,5 - 1 mm (fig. 24). Water moves under pressure

1-1,5 atm., causing sensation of an injection of a needle. Duration of influence by this shower is from 1 about 5

minutes. 15-25 procedures must be carried out daily.

Fig. 24 Grids for needle-bath.

Fan shower is a version of a stream one. For reception of a fan of water an aperture of a tip of a hose squeezed by a

finger or use special nozzle in form of shovel (fig. 25). Influence from distance of 3-4 meters. The patient, facing

shower platform under a fan of water, makes during procedure 2-3 slow turns. A sequence of influence: a back surface

of legs, back extended in the parties of a hand, lateral surfaces of a body, starting with legs and finishing with pits, front

surface of legs, stomach. At the first procedures pressure of water is 1,5 atm., in subsequent it gradually raise up to 3

atm. Procedures by daily duration ' from 1,5 to 3 minutes. On a rate of treatment there are 15-20 procedures.

Fig. 25 Tips for fan-shower.

Circular shower represents a design from thin vertical pipes connected above and below by incomplete rings. On the

internal party of pipes the plenty of fine apertures (fig. 26) is located, through which thin horizontal streams of water

are directed on the patient under pressure 1-1,5 atm. Procedures are daily, duration is from 2 to 5 minutes. On a rate of

treatment there are 15-20 procedures.

Stream douche (Charcot's douche): a compact mobile jet of water. Which is thrown out from a rubber hose through a

metal tip under pressure from 1,5 up to 3 atm.The influence is made from distance 3 -3,5 m. Procedure begin with fan-

shower, directing a fan of water from legs to a head at first behind, then in front. After that influence by a compact jet

in the same sequence, as at fan shower. Duration of procedure is from 1 to 5 minutes. On a rate of treatment there are

15-25 daily procedures.

The Scottish shower is stream shower, the method of its realization, is same to Charcot's shower. There is a difference

that two jets of water of various temperatures are used alternately. For this purpose on the panel of shower platform

there are two hoses: one for hot, another for cold water. Both jets should be thrown out under identical pressure. This

procedure on mechanical and thermal action most powerful among other kinds of hydrotherapy. Usually procedure

begins from influence by hot water and finish by cold. From procedure to procedure a difference of temperatures

increases. Duration of procedure is from 1 to 3 minutes. The rate of treatment consists of 15-20 procedures, which will

be carried out daily or every other day.

Fig. 26 Circular douche. Fig. 27 Ascending douche.

The douches are also used as local influences. Stream douches (Charcot's, Scottish douches) can be applied

locally. In this case rate of treatment can be increased up to 30 daily procedures. A popular kind of local influence -

ascending (perineal) douche (fig. 27). In this procedure the same grid is used, as at raining douche, but its apertures are

inverted upwards. The patient sits on a special chair having in a seat a cut. Water, acting through a grid, under pressure

from 0,5 up to 1,5 atm gets on perineum. The procedures have duration from 2 to 5 minutes, they will be carried out

daily. On a rate of treatment there are 15-20 procedures. The basic indications to hydrotherapy.

1. Training of adaptive-accomodative mechanisms (hardening).

2. Functional frustration of nervous system: neurosis and neurosis-like conditions, corticovisceral disease.

3. Dyskinesia of internal organs: biliary tracts, intestine, disorder of motility of a stomach.

4. The defeats of a muscle and valvular system of heart at absence of activity of process, in a stage of indemnification

or insufficiency of blood circulation not higher of I stage.

5. The diseases of organs of a support-motor apparatus, of peripheral nervous system (most powerful influence have

vortical and vibrating baths).

6. Chronic non-specific diseases of lungs, first of all chronic bronchitis, bronchial asthma.

7. Vegeto-vascular disfunctions, essential hypertension of I-II stage, arterial hypotony.

8. Diseases of pelvic organs, haemorrhoids, sexual weakness (first of all sedentary baths and semibaths, ascending

douches).

The basic contra-indications to hydrotherapy.

1. Acute and aggravations of chronic inflammatory diseases, purulent inflammation.

2. Essential hypertension of III stage, frequent hypertensive strokes, malignant clinical course.

3. Defeat of a muscle of heart, including atherosclerotic one, at insufficiency of circulation of II stage and more,

infringement of conductivity and rhythm of heart, instable angina.

4. Recurrent trombophlebitis.

5. Disorders of skin:erysipelas, furuncules, trophic ulcers.

II. Balneotherapy.

Balneotherapy - medical application of mineral and gas waters, natural or artificially prepared. They can be used

outwardly, as baths, and inside: drinks, inhalation, enemas, various ways of washings and irrigation. In balneotherapy

except for the thermal and mechanical factors the essential role is played by a chemical irritation caused by complex

scale of mineral salts, gases, microelements, organic connections contained in water. Medical mineral waters are

estimated according general mineralization, ionic structure, gas saturation and gas structure, active reaction of water

(pH), contents of microelements, radio-activity, temperature.

According to general mineralization, expressed in grammes of mineral salts per 1 litre of water, mineral waters are

classified as follows:

low-mineralized, up to 2 g/1;

little mineralization, from 2 up to 5 g/1;

average mineralization, from 5 up to 15 g/1;

High mineralization, from 15 up to 35 g/1;

brines, from 35 up to 150 g/1;

Strong brines, over 150 g/1.

In mineral waters there are more 50 various ions, but as basic it is accepted to consider sodium, chlorine, hydrogen

carbonate (HCO 3) and sulphates (SO4). At definition of type of mineral water by ionic structure take into account

those ions, which quantity makes not less than 20 equivalents - percents. According to this criterion by ionic structure

we single out the following basic waters:

sodium chloride;

hydrocarbonate magnesium-calcium;

chloride-hydrocarbonate sodium.

According to gas saturation, expressed in ml of gas per 1 litre of water, allocate the following mineral waters:

high gas saturated, more than 1000 ml/1;

middle gas saturated, from 1000 up to 100 ml/1;

low gas saturated, from 100 up to 50 ml/1;

poorly gas-saturated, less than 50 ml/1.

For reference of mineral water to the certain type of gas waters take into account those gases, which quantity makes

more than 10 % of total amount of the gases, dissolved of water. The greatest medical meaning have waters:

Carbonic;

sulphate (at pH less than 6,5 - hydrogen sulfide);

Nitric.

Depending on active reaction determined pH, allocate mineral waters:

stron-acidic, less than 3,5;

Sour, from 3,5 up to 5,5;

low-acidic, from 5,5 up to 6,8;

Neutral, from 6,8 up to 7,2;

alkalescent, from 7,2 up to 8,5;

Alkaline, more than 8,5.

In some mineral waters the medical value is defined by microelements (iron, arsenic, iodine, bromine and others),

radio-activity due to radon (Rn) or radium (Ra). These features find reflection in the name of the appropriate water:

ferruterous, iodide-bromine, radon etc. In all mineral waters, especially of weak and small mineralization, there is a

various quantity of organic substances such as humines, bitumens and phenols, bringing the essential contribution to

medical action. The large and long-term work on generalization and specification of criteria of an estimation of mineral

waters has resulted in creation of classification which is taking into account their structure and medical importance. 8

groups are allocated: I (group A) - mineral waters, which action is defined by mineralization and ionic structure which

does not have specific components and properties;

II (group B) - carbonic waters;

III (group C) - sulphate (hydrogen sulfide) water;

IV (group D) - ferruterous waters, arsenious, with the high contents of magnesium,copper, aluminium, zinc, lead;

V (group E) - bromine, iodine and iodine-bromine water;

VI (group F) - radon (radioactive) waters;

VII (group G) - siliceous terms (group of waters containing a silicon acid in quantity more 50 mg/1 and

temperature more 35 C);

VIII (group H) - low-mineralized water with the high contents of organic substances.

Each group is divided into subgroups by gas structure, into classes by anion and subclasses by cation structure.

Only some kinds of balneotherapy will be considered further, at which mineral water as mineral or gas baths is used.

The inorganic mineral substances, dissolved in water, influence first of all on receptors of skin. The gas, dissolved in

water, will penetrate through skin, rendering action as on receptors of skin, and general action.

Hydrochloric baths are referred to mineral ones. The optimum concentration of sodium chloride makes 20-

30 g/1, (high general mineralization). At their artificial preparation on a standard bath, which volume of 200 litres, is

required about 5 kg of the cooking salt. Sea or lake salt can be used, which contain except for sodium chloride other

mineral substances. In a nature sodium chloride waters in the pure state are not present.

Sodium chloride irritates receptors of skin, strengthening thermal action of a bath. The dilatation of vessels of skin is

expressed more considerably, than at influence of a fresh bath of same temperature. The irritating action is kept after

procedure, as on skin there is sunken salt -" a hydrochloric raincoat".

Alongside with functional the morphological changes in skin and its nervous system are observed also. The thickness

of malpighian and horn layers is increased, after repeated baths there appear sites of proliferation of cellular elements,

intensively multiplied fibroblasts and their transition in fibrocytes amplifies.

Nervous fibers grow thicker, fragmentation of axial cylinders going to epidermis is found out. At mineralization of 60

g/1 and more in skin necrosis can be developed.

Sodium chloride bath stimulate by reflex way activity of adrenal cortex, activity of sympathoadrenal system.

Their antiinflammatory and hyposensitized action at some diseases is noticeable, and their sedative analgesic effect is

expressed obviously enough. They render regulating action on the central nervous system, change central hemodynamics

and peripheral blood circulation. In particular, if the patient has chronic venous insufficiency, he observes increase of

tone of peripheral veins in a combination with moderate increase of arterial inflow. As a whole sodium chloride bath

render stimulating influence on function of various organs and systems, improve adaptive-accomodating mechanisms.

The medical procedures will be carried out at temperature of a bath 35-38 C by duration from 10 to 20 minutes

every other day, or two days in succession with a break for the third day. On a rate of treatment it is required from 12 up

to 15 baths. The basic indications to application.

1. Essential hypertentension of I - II stage.

1. Arterial hypotony.

1. Varicose veins, trombophlebitis (in 2-3 months after the ending of inflammatory process).

4. Inflammatory, dystrophic and posttraumatic injure of the musculoskeletal system (arthritis,arthrosis,

spondylosis, results of damages of bones, muscles, sinews).

5. Disease of peripheral nervous system (radiculitis, raduculoneuritis, plexitis, consequence of

poliomyelitis).

6. Some skin diseases (psoriasis, neurodermatitis).

General contra-indications for hydropathy.

Iodine-bromine baths are concerned mineral ones. As against other mineral baths iodine and bromine will

penetrate through skin and lungs, taking part in interstitial exchange processes.

In nature iodine-bromine waters in the pure state are not present. Usually ions of iodine and bromine are

contained in structure of sodium chloride waters. For medical application waters containing iodine in quantity not less 5

mg/l and bromine - not less 25mg/l at average genera mineralization of waters (10 -12 g/l) are used. Water of higher

mineralization is diluted by fresh water. Sodium chloride waters containing only bromine or only iodine, have the

limited distribution. At preparation of artificial iodine-bromine baths take for a basis structure of natural mineral water

of a resort Khadyzhensk (Krasnodar territory), spending on a bath of capacity 200 1 100 g of sodium iodide, 250 g

potassium bromide and 2 kg cooking, sea or lake salt. The action of iodine and bromine, accepting direct participation in

exchange processes, is realized on a background of action of sodium chloride, irritating receptors of skin. It is known,

that the biological activity of iodine is caused by its organic compounds in form of hormones of thyroid gland. Bromine

is collected in hypophysis, as the medical means matters in normalization of functions of the central nervous system.

First of all it is necessary to note beneficial effect of iodine-bromine baths on function of the central nervous

system directed on strengthening of processes of inhibition. The broken functions of vegetative nervous system are

corrected. One of consequences of perfection of activity of central regulatory mechanisms is the improvement of

parameters of hemodynamics: reduction of frequency of heart beats, some increase of their force, decrease of arterial

pressure, improvement of microcirculation. The influence on nervous system is realized in its peripheral departments as

increase of a threshold pain and tactile sensitivity that is shown by pain-killing effect, normalization of muscle tone, of

tendinous reflexes. Pain-killing action is appreciable at neuralgia, especially at lumbosacral radiculitis.

Iodine-bromine baths actively influence function of endocrine system: the functional activity of hypophysis to

adrenal glands raises, the activity of sympathoadrenal system, thyroid gland changes. In experiment and clinical picture

we got proofs of inhibiting influence of these baths on development of atherosclerosis. They render also some

bacteriostatic action.

The medical procedures will be carried out at temperature of a bath 35-37 C by duration from 10 to 15 minutes

every other day, or two days in succession with a break for the third day. On a rate of treatment it is required from 15 up

to 20 baths.

________________Basic indications to application:______________________________________________________

1. Functional disorders, consequence of traumas of the central nervous

system, hypothalamic syndrome.

1. Essential hypertention of I - II stages.

3. Disease of paripheral nervous system (radiculitis, radiculoneuritis,

plexitis, consequence of polyomyelitis).

4. Inflammatory and degenerative-dystrophic disease of the musculoskeletal system (arthritis, arthrosis,

spondylosis).

5. Endocrine diseases (hyperthyroidism of light and average difficulty,

hypophysial adiposity, endocrine caused female sterility).

5. Some skin diseases (psoriasis, neurodermatitis, and eczema).

General contra-indications for hydropathy.

Sulfide baths are referred to mineral, because they do not possess one of attributes of gas baths: action of

bubbles of gas upon the skin. In natural waters sulfides are present as ions, mainly hydrosulfide (HS ~) and as the

molecular form - hydrogen sulphide (HS). Ratio of these components is defined by active reaction of water, depending

on which sulfide waters are subdivided into the following groups:

1. Hydrosulfuric,with pH less than 6.5 and hydrogen sulphide makes

more than 75 % of all sulfides.

1. hydrosulfuric-hydrosulfide with pH from 6,5 up to 7,0 and hydrigen

sulfide prevails the ion of hydrosulfide.

1. Hydrosulfide-hydrosulfuric,with pH from 7.0 up to 7,5 and the ion of

hydrosulfide prevails hydrogen sulfide.

1. Hydrosulfide,with pH more than 7.5 and the ion of hydrosulfide

makes more than 60 % of all sulfides.

The majority of natural waters concerns to hydrosulfuric-hydrosulfide and hydrosulfide-hydrosulfuric. It is

considered, that hydrogen sulfide renders more expressed biological action, than ions of sulfides. To medical are referred

waters containing not less than 10 mg/l of sulfides. On concentration of sulfides, designated also by term " general

hydrogen sulfide ", mineral waters are divided into:

1. Weak hydrogen sulfide - from 10 up to 50 mg/1 (0.3 - 1,5 mmol/l).

1. Average - from 50 up to 100 mg/l (1,5 - 3,0mmol/l).

1. Strong - from 100 up to 250 mg/l (3,0 - 7,5 mmol/l).

1. Especially strong - more than 250 mg/l (7.5 mmol/l).

At preparation of artificial sulfide baths for a basis take structure of natural water of a resort Matsesta (resort

area of Sochi), of strong concentration. They are prepared by chemical way, using sodium sulfide, sodium

hydrocarbonate, hydrochloric acid and cooking salt. It is necessary to mean, that hydrogen sulfide is toxic and at

application of baths the combined extract and input ventilation is necessary. Hydrogen sulfide is chemically aggressive,

especially in relation to metals, pipes and cranes from polythene therefore are used. All this complicates application of

sulfide baths out of resort conditions. The answer-back reactions of organism to action of sulfide baths depend first of all

on quantity of hydrogen sulfide, working both on skin and mucous environments, and on internal tissues, where it gets

throug skin and lungs. Its high concentration is toxic.

The most favorable changes are observed at use of sulfide water of average concentration.

Peripheral and central nervous structures are especially sensitive to action of sulfide ions and hydrogen sulfide.

Reactivity of nervous system of skin changes, the threshold of excitability of the sensitive nervous endings is reduced,

that is shown pain-killing action. Hyperemia of skin occurs, which differs by appearance and keeps longer, than

hyperemia, caused by other mineral baths and temperature influence. The sharp border of a zone of hyperemia at that

level is appreciable, up to which the part of a body is shipped in a bath.Hyperemia is connected with reflex reactions

caused by influence of free hydrogen sulfide on the nervous endings, and also formation of histaminoid substances in

skin. Hydrogen sulfide, getting in blood flow, influences on receptor zone, especially carotid sinus and aortic. It will

penetrate through blood-brain barrier and change a functional condition of cerebral cortex, subcortex formations. The

essential influence hydrogen sulfide renders on system hypophysis-adrenal glands, weakening the phenomena of

hypocorticism, restoring vascular reaction. Central reflex and neuro-humoral change, and also the redistribution of blood

flow from internal bodies to periphery and effect functioning of cardiovascular system: the frequency of beats decreases,

their force is increased, arterial pressure is reduced.

Hydrogen sulfide is active reducing agent. Under its influence the quantity of sulfhydric groups in tissues

accrues, the activity of choline esterase, enzymes of reamination and glycolysis raises, the processes of tissue breath

amplify, the exchange of mucopolysaccarides is normalized. The power resources of tissues raise. The specified changes

alongside with neuro-humoral influences, favorably have an effect on current of inflammatory process as change of its

intensity, the allergic reactions are reduced.

The influence of sulfide baths on atherosclerotic process is connected with activation lipase, decrease of

biosynthesis of greasy acids and cholesterol through suppression of activity of a pentous cycle. In some experiments was

observed even resorption of lipid plaques.

Thus, favorable influence on central and peripheral hemodynamics, immunological reactions of organism,

oxidation-reduction processes allow to use sulfide bath at treatment of many different pathological condition.

The medical procedures should be carried out at temperature of a bath 35- 37C usually on a so-called step

technique: gradual increase of concentration of sulfides from 50 up to 100 and then up to 150 mg/l by increase of

duration of a bath from 7 about 15 minutes. The baths should be carried out in day or two days in succession with a

break for the third day. On a rate of treatment are required 12-14 baths.

The basic indications to application:

1. Essential hypertension of I -II stage.

1. The diseases of a muscle and valvular system of heart in a stage of

indemnification or at insufficiency of circulation which is not higher than a stage, not earlier than in 6 months after

termination of active process.

3. Inflammatory and degenerative-dystrophic diseases of musculo-

sceletal system.

4. Diseases of peripheral nervous system (radiculitis, radiculoneuritis)

The contra-indications are general for hydropathy, and also active hepatitis and cirrhosis of a liver, chronic

glomerulonephritis, chronic bronchitis with bronchoobstructive syndrome, bronchial asthma.

Radon baths are version of radon therapy. Radon waters are applied as

irrigations, lavements, so-called "dry" baths, inhalations, drinks. Radon is formed at disintegration of radium and

represents inert radioactive gas without a smell and color. The period its half-decay is 3,8 days. Earlier these baths were

referred to gas ones, but volume of the gas, dissolved of water, is insignificant so it can not render action peculiar to gas

baths. At disintegration of radon a number of its short-

living affiliated products is formed, the period of thier half-decay makes on the average 35 minutes.

The majority of radon waters differs by low general mineralization (less than 2 g/1), they quite often contain

carbonic gas or nitrogen. Some Ural and Issyk-Kul radon waters have mineralization 10-15 g/1, being on ionic structure

sodium chloride or calcium-sodium chloride. Radon waters are classified according to radio-activity, measuring system

expresses in terms of Bequerel (1 bequerel - 1 act of disintegration per one second), but quite often on former use units

of Curie. Medical radon waters should have minimum radio-activity about 0,2kbq/l (kilobequerel per litre of water), that

corresponds 5ncr/l (nanocurie per 1 litre of water). Distinguished the following radon waters:

1. With small concentration of radon (weak radon) - from 0,2 up to 1,5 kbq/l or from 5 up to 40 ncr/l.

1. With average concentration of radon (average radon) - from 1,5 up to 7,4 kbq/1 or from 40 up to 200

ncr/l.

1. With high concentration of radon (high radon) - is higher than 7,4 kbq/l or 200 ncr/l.

Earlier concentration of radon was expressed in terms of Maxe; 1 unit of Maxe corresponds to 0,13 kbq/l or

3,64 ncr/l.

At preparation of artificial radon waters radium is used, which is kept as its soluble salts in hermetic closed

capacity supplied by leaden protection. Such design refers to the generator of radon. In process of accumulation of radon

in the generator it is transferred into the tightly closed vessel; where radon is dissolved in water either spirit at shaking or

hashing of the solvent by the electropump. As a result of these operations receive the concentrated solution of radon,

which spill in tightly closed glass bottles of capacity 100 ml with such account that from every bottle it was possible to

prepare a bath of capacity 200 litres containing 1,5; 3,0 or 7,4 kbq/l of radon. Most frequently are used average radon

bath with concentration of radon 1.5 and 3,0 kbq/1 (40 and 80 ncr/l). Now realizations radonotherapy needs creation of

the centralized laboratory, which should supply hydropathic establishments of city with the concentrated solution of

radon.

At reception of a bath on skin is besieged radon and products of its disintegration, forming so-called active

thin cover, which action is kept within several hours after an exit from a bath. Very small quantity of radon and products

of its disintegration will penetrate through a skin and lungs into internal environments of the organism, being non-

uniformly distributed in tissues. In subsequent about 90 % of them is deposited in skin, fatty tissue. Among all internal

bodies the biggest amount of radon is found in lungs.

The biological and medical action of a radon bath is connected to radioactive radiation, basically with alfa-

radiation. In this connection radonotherapy is referred to version of alfa-therapy. Under action of radiation there is an

ionization of molecules of tussue and water. At ionization of water the chemical radicals being powerful oxidizers are

formed: atomic oxygen, ozone, hydrogen peroxide and others. The direct action of alfa-rays oupon biostructures of cells

matters also. The reaction of skin to effect of radon baths is expressed in change of skin sensitivity. In the skin analyzer

begins to prevail processes of inhibition. The vessels of skin in the beginning of procedure are narrowed so that it turns

pale, in subsequent hyperemia occurs . It is known, that a nervous tissue and endocrine system are very sensitive to

ionizing radiation. On the central nervous system radon bath render sedative effect reminding action of tranquilizers.

Analgesic action of these baths connect both to decrease of excitability of peripheral receptors, and with blockade of

ways of realization of pain pulses. Influence on alfa- and beta-adrenoblockers results in change of activity of cardio-

vascular systems. The bent to tachycardia is observed, arterial pressure is reduced. Radon bath can render normalizing

action on frequency of beats, reducing it at tachycardia and increasing - at bradycardia, normalizing action on a level of

arterial pressure at hypertesion or hypotonia.

The influence upon endocrine system is shown by activation of sympathoadrenal system through of adrenergic

nervous endings. The function of cortex of adrenal glands is stimulated, function of ovaries is normalized, function of

thyroid gland is raised.

Radon bath influence upon metabolic processes at cellular level, influencing on all kinds of an exchange. A

number of enzymatic systems is activated, the pressure of oxygen in tissues raises. The parameters of immunologic

reactivity of the organism are normalized, there are observed both hyposensibilizing, and immunomodulating effects

depending on character of pathological process. All this positively has an effect for current of inflamatory process,

including immunologically caused: its activity is suppressed, the reparation of tissue is accelerated. Cicatricial tissue is

sated by glycoseaminoglycones, that makes it more elastic, the formation of rough scars is prevented.

As a whole is marked, that radon baths stimulate adaptive system of organism of the patient, have expressed

analgesic, antiinflammatory action, normalizing exchange processes.

The medical procedures should be carried out at temperature of a bath 35-37 C, daily or every other day.

Duration of procedure from 10 to 15 minutes. It is recommended to begin treatment from a bath, of duration 10 minutes,

to increase it by 1-2 minutes at the subsequent procedures, having finished up to 15 minutes. On a rate of treatment it is

required from 15 up to 20 baths.

The basic indications to application:

1. Inflammatory, degenerative-dystrophic and posttraumatic diseases of

musculosceletal system, including consequences of bone fractures with the slowed down consolidation, steomyelitis.

2. Diseases of peripheral nervous system (radiculitis, radiculoneuritis,polyneuritis,

neuralgia).

3. Chronic inflammatory processes, in particular of female sexual sphere, pyelonephritis.

3. Functional disorders and consequences of traumas of the central nervous system.

5. Essential hypertension of I-II stage.

5. Some skin diseases (psoriasis, neurodermatitis).

Contra-indications to application, except for general to hydropathy,

pregnancy, stenocardia.

Carbonic acid gas bath are referred to gas ones.The typical feature of such bath is oversaturation of water

with gas, that evolves in bath in form of blebs

Except for carbonic baths are used oxygen, nitric, pearl (bath with raging in water blebs of air).

To medical carbonic baths are referred the ones that contain not less than 0,75 g of carbonic gas per litre of

water, irrespective of its mineral structure. Natural carbonic waters have very various general mineralization, making

from 1-5 till 15-35 g/l. They are various on their ionic structure. Sulfate (sulfate narzan), hydrocarbonate calcium-

sodium, hydrocarbonate magnesiun-calcium are distributed. Many of them contain biologically active microelements:

arsenic, iron, boron and others.

The artificial carbonic baths are prepared by physical or chemical methods. In a physical method water is sated

with carbonic gas leaving a cylinder, with the help of the special device (AH-8, AH-9). After installation of the device

its working mode is worked out. Thus check by a chemical way concentration of carbonic gas in a bath at different

pressure, duration of saturation and temperature of water. On a ratio of these parameters develop modes of operations of

the device, at which it is possible to receive required concentration of carbonic gas. The chemical method is based on a

principle of replacement of carbonic gas by an acid from carbonic salts. A source of it can be sodium hydrocarbonate,

sodium carbonate, which influence by a hydrochloric or sulfuric acid. In special manuals there are recipes and accounts

of preparation of carbonic baths of the given concentration. The optimum medical effect is observed in a bath at

concentration of carbonic gas 1,2-1,4 g/l, in which on 1 ml of water 60-70 blebs of gas are necessary. The mechanical

and thermal factors in a carbonic bath, as well as in other gas baths, have the features. Blebs of gas are deposited on skin,

and then come off, causing original tactile massage. More considerably, than in a fresh or mineral bath irritating action

on thermoreceptors of skin. Indifferent temperature of waters is 34-37 C, and carbonic gas - 12-13 C. In the appropriate

bath on a surface of a body work alternately gas perceived as hotter, and water perceived as more cold. Besides on

receptors and vessels of skin the carbonic gas influences, plenty of which is deposited in skin. The fine vessels of skin

extend, hyperemia occurs. The activity of thermal thermoreceptors raises, and cold-receptors - is reduced. In spite of the

fact that because of strengthening of circulation in superficial tissues is increased heat emission and temperature of a

body is reduced, the carbonic baths of indifferent temperature and even cool can be perceived by the patients as warm.

Hence, there is a discrepancy of heat sensation and thermal effect that is necessary to take into account at realization of

procedures. The expansion of superficial vessels results in redistribution of blood flow to periphery. The carbonic gas

gets into organism through skin and lungs in the increased amounts, its contents in air above a bath is increased up to

1,2-2 %, that corresponds to pertial pressure 15-16 mm mercury. Raising the respiratory centre, it promotes increase of

minute volume of breath, sticking action of chest and, as the consequence of it, venous inflow to heart is increased.

Hemodynamic effects of carbonic baths are shown first of all in lengthening of diastole, substantial growth of cardiac

emission, reduction of frequency of beats, that is especially appreciable at previous tachycardia. The decrease of a pulse

rate is regarded as an attribute of adequacy of influence of a carbonic bath. On the central nervous system the carbonic

gas works excitingly. Vasomotor centers are raised maximum , that is shown by increase of arterial pressure for the

persons suffering from hypotonia. Especially it is appreciable at application of cool and cold baths. At initial raised

arterial pressure it can be reduced, is especial at application of baths of indifferent temperature. However use of carbonic

baths for treatment of arterial hypertension is limited because of their stimulating central action, but they can appear

therapy of a choice at arterial hypotonia.

The carbonic baths are first of all method functional methods of pathogenetic therapy of diseases of

cardiovascular system. They stimulate mechanisms of indemnification of cardiac activity, training myocardium, increase

its adaptive ability to loadings. The medical procedures begin from temperature of a bath 35 C gradually reducing it in

the subsequent procedures up to 32 C, less often till 30-28. In process of downturn of temperature of water increase

duration of procedure from 7 minutes (sometimes from 5 minutes) to 12-15 minutes. The baths should be carried out

every other day or two days in succession with a break for the third day. On a rate of treatment it is required from 12 up

to 15 procedures.

The basic indications to application:

1. The diseases of a muscle and valvular system of heart in a stage of

indemnification or at insufficiency circulation which is not higher than I

stage.

1. Arterial hypotonia.

3. Functional disorders of the central nervous system with the phenomena of depression.

Contra-indications, except for general to hydropathy, hypersthenic form of neurasthenia.