Dr.Hab., Professor G.N. Ponomarev¹
Postgraduate A.S. Orlov^{1, 2
1}Herzen State Pedagogical University of Russia, St. Petersburg
²«Advanced health technologies» Clinic, St. Petersburg

Keywords: specialist training, musculoskeletal system correction exercises.

Introduction. Musculoskeletal diseases have become widespread in recent years with pain in the back and limbs not related to internal organs malfunction being their main feature. Limited spine mobility may be a factor contributing to the disease development as well as its consequence. 

Physical exercises intended to restore the impaired static and dynamic movement patterns serve as the main means of rehabilitation and prevention of musculoskeletal disorders [2]. A very important point is that exercise is a tool that ensures a healthcare effect only in case of correct application [4]. At the same time graduates of physical culture institutes and departments do not have the necessary knowledge and skills that can reduce the risk of musculoskeletal diseases [3].

Objective of the study was to develop and approve a set of special physical exercises geared to prevent and correct a variety of spinal and musculoskeletal disorders and diseases, the exercises being expected to contribute to the physical education specialist training curricula.

Study structure and methods. An educational experiment has been carried out in the "Advanced health technologies" Clinic for 5 months. Subject to the study were 40 persons with acute or chronic pain syndrome associated with musculoskeletal impairments. The participants were split into two groups (study and reference), 20 persons in each. The study group     performed a special set of exercises (independently or under the teacher's supervision at the clinic) 2-3 times per week, mainly in the afternoon. Physiotherapy was used 3 times in both groups at the beginning of the experiment. A monthly visit to the "Advanced health technologies" Clinic for a training session under medical and pedagogical supervision was a prerequisite for the study group subjects. Functional values of a patient (heart rate and blood pressure) were assessed during the training session. The teacher visually assessed the quality of performance of physical exercises and accuracy of motor skill formation. Subjective sensations of complexity and severity of the performed exercises were identified. Exercises for other muscle groups were added depending on the state of health, ability and willingness of the subjects. Based on a comprehensive assessment of all the above indicators the necessary recommendations for further training were given to the patient and his training load was adjusted according to the individual adaptive capabilities of his body. Both groups were tested using an integrated face and visual analogue pain scale (VAS Pain) at the beginning and at the end of the experiment [1]. In addition, there was carried out a 5-month monitoring of the dynamics of exacerbation of the pain syndrome in patients from the study and reference groups.

An educational module program “Musculoskeletal disease prevention and correction” (hereinafter - “module” program) was designed during the experiment. In addition to a set of special physical exercises for prevention and correction of spine and musculoskeletal diseases it includes physiotherapeutic tools: functional massage and manual therapy techniques; percutaneous electrical neuromyostimulation, orthopedic products for activity and rest.  

In order to test its effectiveness a set of special physical exercises geared to prevent and correct spinal and musculoskeletal diseases was applied in a comprehensive prevention program of spinal degenerative and dystrophic diseases in the "Advanced health technologies" Clinic. 

The set of special exercises is meant to strengthen core muscles of the spine, particularly “postural” muscles. The ability to maintain balance in the upright position is one of the most important conditions for the interaction of humans and the environment. Antigravity muscles (extensor muscles of the spine, hip and knee joints) are primarily responsible for postural control during standing (posture regulation).

1. Lat strengthening exercise. The exercise is performed using a resistance band. Preparatory position: stand with your feet shoulder width apart, arms forward with the resistance band handles gripped with the wrists bent at the nose level. The midpoint of the resistance band is at the nose level for support. The motion is performed with straight arms down and back to the maximum without bending the torso, with hands turned inward and fingers extended in the shape of a fan. Common mistakes: fingers are not extended at the end of the motion; arms held sideward too much.

2. Exercise for strengthening serratus posterior superior and rhomboid muscles. Preparatory position: stand with feet apart, arms bent forward, hands in fists, holding resistance band handles in hands. The motion is performed with arms bent at the elbows, moving them to the sides as much as possible, thus bringing shoulder blades together. Common mistakes: while moving the arms to the sides the fists go below the nose level; elbows are moved sideways too much.

  3. Exercises for strengthening abdominal external oblique muscles. “Spinal twist”. Preparatory position: stand sideways to the support, feet apart, the foot closest to the support with its toe pointing straight, the one farthest from the support is turned with its toe 45 degrees out. Resistance band handles are in one hand, the other hand is on top, and both hands are pressed to the chest at the level of the solar plexus. The midpoint of the resistance band is fixed on the support. Turn the torso by 170 degrees while lifting the heel of the foot closest to the support. Both legs should be straight when turning.

  4.  After all the movements in exercise 3 are performed a certain number of times, turn around and do exercise 3 again standing with the other side to the support.

  5.  Neck strengthening exercise. Preparatory position: stand with feet apart, facing the support. Resistance band handles are attached to the support, its midpoint is put on the back of the head, hands grip the resistance band into fists and are pressed tightly to the forehead. Tilt the head back as much as possible, then return to the preparatory position and bring it a little forward.  

   6. Similar exercise, but the preparatory position is with your back to the support, the resistance band put on the forehead, hands gripping the resistance band into fists, and elbows pressed tightly to the back of the head. Bend the head forward as much as possible to touch the chest with the chin, then return to the preparatory position and move the head back a little.   

   7. Similar exercise, but the preparatory position is standing with your right side to the support, the resistance band is put on the left temporal part of the head, the right hand grips the resistance band into a fist. The head tilted to the left to touch the left shoulder with the ear, then return to the preparatory position and move the head slightly to the right. 

   8. Repeat exercise 7 while standing with the other side facing the support. Common mistakes: hands clamp the resistance band; neck muscles do not move; hands help the movement of the head; the body is engaged in bending.

  9. Erector spinae exercises. Preparatory position: stand facing the support, right leg lunge, the left leg back is straight standing on the toe, bend forward (back is parallel to the floor). Resistance band handles are attached to the support at the level of mid-calf. Resistance band loop is put on the neck, the band goes under the armpits and is twisted twice under the arms. Hands lie of the band freely. Full body extension and retraction of the head backwards are performed. The right leg straightens, the left one is put flat on the foot. Preparatory position of the feet switches every 10 repetitions. Possible mistakes: no tilting of the head back; the supporting leg is not straightened and put flat on the foot.    

The exercises are performed by the circuit training method. There are 45-60 repetitions in each set. Each exercise is performed “to failure”, but not longer than 3 minutes. Rest between the exercises is no longer than 2 minutes. One training session includes from 5 to 10 exercises. The work is performed in submaximal power mode and contributes to muscle mass building, which leads to strengthening of the spinal core muscles. The pulse should be 170-180 beats/min, and in the senior age group – up to 150 beats/min. The closing part of the class (about 20 minutes) includes some aerobic load (running, walking, training on a cycle ergometer) and reduces the concentration of the lactic acid that gets into the blood from the muscles involved in the workout for a quicker recovery. The pulse is gradually brought to the value of 90-100 beats/min. The rubber resistance bands of various elasticity were selected individually depending on the fitness level of the trainees. 

Results and discussion. Table 1 shows the results of testing the subjects using the integrated face and visual analogue pain scale (VAS Pain) at the beginning and at the end of the experiment [1] (Table 1). 

Table 1. Pain intensity indicators by VAS

The dynamics of exacerbation of the pain syndrome in patients of the study and reference groups has been monitored for 5 months. Below is a chart of the pain syndrome “exacerbation index” dynamics. The value of the Student’s t-test is 5.89, the differences in the exacerbation indices in the study and reference groups are statistically significant (р<0.05).

Conclusions. The use of a set of special physical exercises combined with physiotherapeutic treatments is effective, and the set of exercises itself is one of the important independent tools for prevention and correction of musculoskeletal disorders and diseases.  Consequently, in order to ensure mass prevention of musculoskeletal diseases among the population, every future physical education specialist should know and be able to apply the proposed set of physical exercises. 

References

1. Byval'tsev V.A. Primenenie shkal i anket v obsledovanii patsientov s degenerativnym porazheniem poyasnichnogo otdela pozvonochnika: metod. rekom. (Use of scales and questionnaires in examination of patients with lumbar degenerative diseases: method. recom.) / V.A. Byval'tsev, E.G. Belykh, N.V. Alekseeva, V.A. Sorokovikov. – Irkutsk: NTsRVH» SO RAMN, 2013. – 32 p.
2. Oreshkin Yu.A. Fizicheskaya aktivnost' - sredstvo sovershenstvovaniya organizma (Physical activity for body improvement) / Yu.A. Oreshkin // K zdorov'yu cherez fizkul'turu (Physical education for health) / Ed. N.A. Fedorova. – Moscow: Meditsina, 1990. – P. 6–12, 41–77.
3. Ponomarev G.N. Podgotovka spetsialistov fizicheskoy kul'tury: integratsiya obrazovaniya i sportivnoy nauki (Physical education expert training: integration of education and sport science) / G.N. Ponomarev // Kul'tura fizicheskaya i zdorov'e. – 2011. – № 6(36). – P. 11–14.
4. Rodichkin P.V. Reabilitatsiya i profilaktika retsidivov u patsientov s zabolevaniyami oporno-dvigatel'nogo apparata (Rehabilitation and relapse prevention in patients with musculoskeletal system diseases) / P.V. Rodichkin, P.V. Pupkov, N.S. Shalamanov, A.S. Orlov // Dvigatel'naya aktivnost' i zdorov'e uchashcheysya molodezhi: Sb. mater. nauch.-prakt. vseros. konf. «Gertsenovskie chteniya» (Motor Activity and Health of students: Proc. res.-prac. conf. "Herzen readings"). – St. Petersburg: Herzen RSPU pub. h-se, 2014. – P. 85–88.

Corresponding author: g-ponomarev@inbox.ru

Abstract. Physical education specialist training system designed for a variety of modern demands and missions is ranked among the top priorities in the public health protection and improvement initiatives being implemented in the Russian Federation. However, it is the currently poor education quality of the university graduates in the pupils’ health protection area that is prioritized among the key problems in the Teachers’ Education Modernization Program. Vocational background of a physical education specialist will be versatile enough to address any issue in the national education environment. In the transition of the national education system to the Federal State Higher Education Standards (FSHES), a new content of the theoretical and practical education components and education quality rating systems will be developed. A modern physical education specialist will be trained to address a variety of modern challenges and, therefore, the university education methods need to be revised to make them more individualized and more focused on individual health standards, mental and physical development problems and needs, and different motor fitness levels.
The study was designed to develop and approve a set of special musculoskeletal system correction exercises geared to prevent and correct a variety of spinal and musculoskeletal disorders and diseases, the exercises being expected to contribute to the physical education specialist training curricula. The study results gave the grounds to rate the proposed exercises as highly efficient.