Family Medicine General Provisions PDF

Family medicine. General provisions. The main functional duties of a family doctor. Principles of dispensary. Peculiarities of medical examination of different groups of the population Lecturer: Bogatyreva M.M. The main goal of your coming here is to get a high...

Family medicine. General provisions. The main functional duties of a family doctor. Principles of dispensary. Peculiarities of medical examination of different groups of the population Lecturer: Bogatyreva M.M. The main goal of your coming here is to get a high-quality education and a worthy diploma, worthy of our institute and you. As future doctors you need to learn to come on time and develop a very important information, so try not to miss classes. Treat the teacher with respect, give way, open the doors, greet, teacher shares his or her knowledge and experience with you, appreciate this. 1. Family medicine. Health care. Types. 2. Basic functions of a family doctor. 3. Prevention. Types. 4. Clinical examination Purpose and tasks. Kinds. 5. Stages of medical examination. 6. Medical checkup. Kinds. 7. Types of consultations. 8. Diagnostic criteria for risk factors. 9. Comprehensive assessment of the child's health. 10. Rehabilitation. Kinds. 11. Medical rehabilitation for chronic 12. obstructive pulmonary disease. Definition. Kinds. 13. Aerosol therapy. Definition. Methodology. Indications and contraindications. 14. Halotherapy. Definition. Methodology. Indications and contraindications. 15. Speleotherapy. Definition. Methodology. Indications and contraindications. 16. Pulse electrotherapy. Definition. Methodology. Indications and contraindications. 17. Inductothermy. Definition. Methodology. Indications and contraindications. 18. Vibro-thermomagnetic therapy. Definition. Methodology. Indications and contraindications. 19. Magnetic therapy. Definition. Methodology. Indications and contraindications. 20. Medical rehabilitation in cardiovascular pathology. Physical and mental rehabilitation. 21. Principles of Medical Rehabilitation patients with myocardial infarction. 22. Principles of medical rehabilitation of patients with cerebrovascular diseases 23. Fundamentals of medical rehabilitation of post-stroke sick. 24. Principles of Medical Rehabilitation after operations on the digestive organs 25. Medical rehabilitation of patients after gallbladder surgery and bile ducts. 26. Medical rehabilitation in urological and nephrological diseases Family medicine - represents long-term medical care healthy and sick, regardless of age and sex (family), in which special attention is paid to a comprehensive study of the personality, its family and social environment. Primary health care (PHC) - the leading service and the main link system of Human Health Protection, which provides assistance on the basis of the principle “from periphery to the center” and is an integral part of the social and economic development of the country. This assistance is provided by general practitioners , practitioners or family doctors SECONDARY health care is provided by doctors of a narrow specialization, provides more qualified care within the district/city hospitals. TERTIARY - diagnoses complex cases that are rare disease.  MAIN FUNCTIONS OF A FAMILY PHYSICIAN: 1. Outpatient reception, home visits; organization of day and home hospitals. Carrying out medical and diagnostic, rehabilitation, preventive measures: early diagnosis, provision of first, perinatal help, often - minor surgery, certain honey. manipulation (e.g., maintaining pregnancy), using inexpensive methods of examination and treatment. 2. Provision of emergency and emergency medical care; 3. Help in solving medical and social problems of the family: study, analysis of physical, psychologist's, social factors for health and development, the course of the disease. 4. Makes the primary decision on all problems: monitoring patients with O., Chr. diseases, and for those who are in a terminal state. 5. Establish a trusting relationship with the patient, conduct training the patient and his family. 6. Collaborates with colleagues, consultations, consultations; 7. Aware of his responsibility to society. 8. Carrying out anti-epidemic measures. 9. Informing about cases of infectious diseases. diseases to the doctor of the office Prevention in medicine is a wide and versatile field of activity, aimed at identifying the causes of diseases and injuries, their elimination or weakening in individuals, groups and the general population. Primordial prevention is a set of measures aimed at preventing the impact of risk factors for the onset of a disease associated with adverse living conditions, the environment and work environment, and lifestyle. Primary prevention is a system of measures aimed at eliminating or reducing unfavorable for health factors and causes of the disease, strengthening of beneficial factors and, thus, to reduce the likelihood of the occurrence of the disease. Primary prevention technologies consist of the formation of risk groups, screening; lifestyle counseling and lifestyle modification; a comprehensive system of measures to prevent diseases; integration of the work of various services and departments involved in primary prevention; vaccination and chemoprophylaxis; control over the state of health, increase the level of health, responsibility for the health of the person himself. Secondary prevention is a set of medical measures aimed at timely detection and treatment of existing diseases. It provides for the use of specific measures implemented by medical institutions to prevent the progression of existing diseases, their early detection, effective treatment and rehabilitation. Secondary prevention includes medical examinations for adults and children. Organization of dispensary observation is determined by regulations. Tertiary prevention (rehabilitation) is a system of measures aimed at reducing the likelihood and prevention of the development of complications of the disease, their disabling consequences. In the preventive work of the local doctor, there are three main areas: 1. Health education of the population of the site; 2. Participation in preventive vaccinations; 3. Clinical examination of the population. Clinical examination - active dynamic monitoring of the state of health of the population, including a set of preventive, diagnostic and therapeutic measures. Initially, the principles and methods of clinical examination were used to combat socially dangerous diseases - tuberculosis, syphilis, trachoma, etc. Subsequently, the dispensary method was used to monitor pregnant women, children, workers in leading industries and agricultural production, patients suffering from chronic diseases. The purpose of the dispensary is: formation, preservation and strengthening of public health, disease prevention, reduction of morbidity, disability, mortality, achievement of active longevity. Clinical examination is included as an integral part of a wide system of measures for the prevention of diseases carried out by the state and society. The main tasks of medical examination of the population are: 1. Determination of the health status of each person during annual preventive examinations, health assessment taking into account age, gender and professional characteristics; 2. Differentiated active dynamic monitoring of healthy people; persons those with risk factors and patients; gradual transition from observation to individuals to family observation; 3. Identification and elimination of causes causing diseases; promoting the elimination of bad habits and ensuring a healthy lifestyle; 4. Timely implementation of medical and recreational activities; 5. Improving the quality and efficiency of medical care for the population through interrelation and continuity in the work of all types of institutions, the wide participation of doctors of various specialties, the introduction of new organizational forms, further technical support. Clinical examination has taken a leading place among doctors of various specialties, in first of all, general practitioners, territorial and shop medical districts. For effective and high-quality medical examination, it is necessary: active identification of patients in the early stages of the disease; systematic monitoring of their state of health; timely implementation of therapeutic and preventive measures for the speedy recovery of health and ability to work; study of the external environment, production and living conditions and taking measures to improve them; systematic advanced training of doctors, both in the main specialty and on issues of occupational health, occupational diseases, examination of temporary disability; participation in the medical examination of the administration of enterprises, trade unions and other public organizations. Among the entire population subject to dispensary observation, primarily under observation should be taken by persons with harmful and difficult working conditions; students (vocational schools, technical schools and universities), working teenagers, regardless of the nature of production and industries; invalids and veterans of the Patriotic War; women of childbearing age; patients according to the main groups of diseases, persons with an increased risk of disease: with high blood pressure, with  Institutions differ in the degree of their participation in the medical examination of the population. on the following levels: Level I - outpatient clinics serving the population on a production or territorial basis: medical outpatient clinics, health centers, medical centers, territorial polyclinics, women's consultations. At this level, automation of the diagnostic process is necessary; collection of anamnesis data, analysis of ECG and FLG, laboratory diagnostic studies, functional and psychophysiological tests; solution of administrative and organizational tasks. Level II - specialized dispensaries, hospitals, consultative and diagnostic centers. At this level, along with the tasks of general screening, an in-depth examination of cardiological, oncological, pulmonological, ophthalmological, neuropsychiatric and other profiles is provided. Level III - regional, regional and republican hospitals, specialized centers, clinics of medical and research institutes. Technology focused on the use of all modern and promising methods of diagnosis and treatment, the creation problem-oriented databases and databanks for patients of the corresponding profile, and as well as individual regions of the country. The first stage of modern medical examination of the adult population includes planning work on medical examination of the population: conducting a population census at the site, selecting a list of persons subject to active dynamic observation in a medical institution, determining the order of invitations for medical examinations and an individual examination program. The first stage is a combination of screening research methods, additional research methods, individual preventive counseling and examination of the local family doctor (therapist). As part of the first stage, the following types of screening are carried out: cardiovascular screening for arterial hypertension (blood pressure measurement, questioning), hypercholesterolemia (cholesterol level measurement), suspicion of coronary heart disease (questionnaire), suspicion of acute cerebrovascular accident (questionnaire), suspicion of heart failure in the elderly (questionnaire), as well as to determine the value total cardiovascular risk; screening for suspected cervical cancer (Papanicolaou test), breast gland (mammography), colon (immunochemical test for the presence of occult blood in feces); screening for suspected chronic obstructive pulmonary disease (questionnaire); screening for suspected diabetes mellitus (determination of glucose levels); screening for suspected tuberculosis (fluorography); screening for frailty in persons aged 75 years and older (questionnaire). Screening research methods must meet such requirements as acceptability for the patient, simplicity, reproducibility, high sensitivity and specificity, proven medical and economic efficiency. Given these factors, such methods studies such as a clinical blood test, a detailed clinical blood test, a general The second stage of clinical examination is an active invitation to medical examinations all patients subject to clinical examination. Examination by negotiability and during preventive examinations. Carrying out medical and diagnostic measures, assessing the state of health, determining the health group for each examined patient and is a set of consultations of medical specialists and laboratory and instrumental research methods to clarify the preliminary diagnoses formulated at the first stage. Screening is also carried out for the presence of chronic obstructive pulmonary disease in persons suspected of having it according to the results of the questionnaire at the first stage. At the second stage of clinical examination, in-depth preventive counseling is maintained: for citizens under the age of 72 with diseases associated with atherosclerosis and high blood pressure; for citizens at risk of harmful consumption of alcohol, drugs and psychotropic substances without a doctor's prescription; for all persons over 75 years of age in order to correct the identified risk factors and prevent senile asthenia. Separately, it should be noted that during the survey (questionnaire) of citizens reveals the risk of harmful alcohol consumption and the risk the use of drugs and psychotropic substances without a doctor's prescription, and not the harmful use of alcohol or drug addiction, which are psychiatric diagnoses and can only be established by a psychiatrist narcologist. The third stage of clinical examination is an active invitation to receive patients, under dispensary supervision, carrying out medical and recreational and rehabilitation measures. Evaluation of the quality of medical examination. The main form of conducting active monitoring of the health of the population are medical examinations, which are divided into: preliminary, periodic, targeted  The main form of conducting active monitoring of the health of the population are medical examinations, which are divided into: preliminary, periodic, target. Preliminary medical examinations are carried out upon admission to work or study in order to determine the compliance of the state of health with the requirements of the profession or training. Periodic medical examinations are carried out for decreed groups of the population associated with common physiological characteristics or working conditions (children, adolescents, employees of public catering establishments, children's institutions, household services, etc.). Conducted regularly at regular intervals to assess the condition health and detect early signs of disease. Targeted medical examinations are carried out for early detection of socially significant diseases: tuberculosis, malignant neoplasms, diseases of the circulatory system,  For health reasons, all examined residents are divided into three groups of dispensary observation. Group I - practically healthy. This group includes people who do not have chronic diseases and are fully able-bodied. In this group, acute diseases, however, they do not proceed for a long time and do not lead to dysfunction of individual organs and systems, during the examination they do not find deviations from the established limits of the norm. Group II - risk group. This group includes people who do not have any chronic pathology, but have functional abnormalities, reduced immunological resistance, frequent acute illnesses, as well as risk factors for industrial, household and genetic character. Group III - patients with chronic diseases. Subdivided into persons: with a compensated course of the disease, rare and short-term disability; with subcompensated course of the disease, frequent exacerbations and ongoing disability; with decompensated course, stable pathological changes, leading to permanent disability. In the first group - active dynamic monitoring of the health of healthy persons, as a rule, is carried out once every 1-3 years, but can be built depending on gender, age and physiological state of the patient. The research should be directed to determination of the functional state of individual systems and organs, primarily cardiovascular, respiratory, endocrine, digestion, central and peripheral nervous system, the degree of adaptation of the organism, the identification of reserves. When examining persons from the risk group (group 2), along with the above methods, the reactions of the body's functional systems to dynamic work load, as well as assessing the ability to work. The frequency of observation of this group of dispensary observation increases up to two times a year. In the group of chronically ill patients (group 3), a targeted examination should be carried out, including all modern methods of laboratory, functional diagnostic, X-ray, radioisotope, endoscopic and other studies. The frequency and duration of observation of patients with chronic diseases depends on the course disease, its forms and stages. Thus, the frequency of dispensary observation of patients with rheumatism, coronary heart disease, gastric ulcer and duodenal ulcer gut is four times a year. Planning active examinations for the third group dispensary observation should be built in such a way as to prevent seasonal exacerbations chronic diseases. To improve the detection of breast and colorectal cancer, Once every 2 years mammography (for women from 51 to 69 years old) and examination of feces for latent blood (for ages 49 to 73 years). Each citizen who has undergone a medical examination is issued a Health Passport, which  Types of counseling.  Preventive counseling is the most important prevention technology and correction of risk factors for their development, in connection with which preventive counseling is included as a mandatory component of the medical examination program adult population. Preventive counseling is the process of informing and educating the patient to increase his commitment to the implementation of medical prescriptions and the formation of behavioral skills that help reduce the risk of disease (in the absence of diseases) and complications of diseases (if any).  Individual preventive counseling is carried out at the 1st stage of clinical examination by a health worker. All citizens under 72 years of age with high relative, high and very high absolute cardiovascular risk, and (or) obesity, and (or) hypercholesterolemia with total cholesterol level of 8 mmol / l or more, and (or) smokers more than 20 cigarettes per day. Duration 7-10 minutes.  Brief preventive counseling is carried out at the final 1 stage of clinical examination by a doctor for all citizens with a frequency of 1 time in 3 years. Brief preventive counseling should be part of the doctor's appointment (primary, follow-up, dispensary). Duration 3-5 minutes.  In-depth (individual or group) preventive counseling is carried out at the 2nd stage of clinical examination by a health worker of medical prevention. Duration 30-40 minutes.  As part of the medical examination, the following groups of citizens are subject (and sent by a doctor): citizens under 72 years of age with diagnosed coronary artery disease, CVD, chronic ischemia of the lower extremities atherosclerotic genesis or diseases characterized by high blood pressure; citizens with identified by the results of the survey (questionnaire) the risk of harmful alcohol consumption and (or) the use of narcotic drugs and psychotropic substances without a doctor's prescription; citizens aged 75 and older in order to correct identified risk factors and (or) prevention of senile asthenia.  Diagnostic criteria for risk factors and other pathological conditions and diseases that increase the likelihood of developing chronic noncommunicable diseases:  Elevated blood pressure - systolic blood pressure equal to or higher than 140 mmHg, diastolic blood pressure equal to or higher 90 mmHg or antihypertensive therapy. Citizens with this risk factor include citizens with hypertension or symptomatic arterial hypertension. also citizens with high blood pressure in the absence of a diagnosis of hypertension or symptomatic arterial hypertension  Hypercholesterolemia - the level of total cholesterol is 5 mmol/l or more. Hyperglycemia - fasting plasma glucose level of 6.1 mmol / l and more or the presence of diabetes mellitus, including if normoglycemia is achieved as a result of effective therapy.  Tobacco smoking - smoking at least one or more cigarettes daily  Irrational nutrition - excessive caloric intake of food, (including - dietary salt more than 5 grams per day), insufficient intake of fruits and vegetables (less than 400 grams or less than 4-6 servings per day), sea fish and seafood (less than 2-3 servings per week).  Overweight - body mass index 25-29.9 kg/m2  Obesity - body mass index of 30 kg/m2 or more  Lack of physical activity  The risk of harmful alcohol consumption and the risk of using narcotic drugs and psychotropic substances without a doctor's prescription  Burdened heredity for CVD. Burdened heredity for malignant neoplasms.  The basis of the preventive work of a pediatrician is a comprehensive assessment of the child's health using six main criteria. The first criterion that determines health is the identification of deviations in ontogenesis (biological, genealogical and social anamnesis). This criterion provides a more objective description of the level of health of a newborn, infant age, second, third year of life, and also allows predicting health in early childhood, identifying risk groups. The second criterion is the level of physical development and the degree of its harmony. The third criterion is the level of neuropsychic development. The fourth criterion is the level of resistance of the organism. The fifth criterion is the level of the functional state of the body. The sixth criterion is the presence or absence of chronic diseases or congenital developmental defects.  After examining and evaluating all health criteria, the pediatrician makes a conclusion about the child's belonging to the appropriate health group (I, II, III IV, V). The first group - healthy children who do not have deviations in all signs of health, do not sick during the observation period, or having minor single deviations, not affecting the state of health, not requiring correction. The second group - also healthy children, but with an unfavorable genealogical history - group II A; II B group: children at risk of chronic pathology, prone to increased morbidity, with functional abnormalities due to morphological immaturity of organs and systems, with a burdened obstetric history, often those who are ill or have had one serious illness with an unfavorable course of the rehabilitation period, etc. The third group - sick children with chronic (or acute - for example: acute glomerulonephritis. ARF) pathology, malformations in a state of compensation, The fourth group of health - sick children with chronic pathology in a state of subcompensation, The fifth group - sick children with chronic pathology in a state of  Rehabilitation The goal of rehabilitation is an effective and as early as possible return sick and disabled people to socially useful activities, the formation of a sustainable positive attitude to life, work, education, family, society (Stukolova T.I. 2005). Rehabilitation involves the participation of various specialists in this process, and therefore, there are medical, social, pedagogical, legal, professional and other types of rehabilitation. Dispensary observation of children with various diseases is directed at full elimination of pathological changes, or for the maximum possible compensation of congenital or acquired defects. The most important section of medical examination of sick children is rehabilitation treatment (medical rehabilitation), which meets the objectives of secondary prevention, which provides for active dynamic monitoring of identified patients, timely and high-quality provision of the necessary qualified medical and diagnostic care , health-improving measures in order to ensure their complete recovery, reduce the frequency of recurrent cases of diseases, prevent the occurrence of chronic pathology and disability.  Basic organizational principles of medical rehabilitation: - inclusion of rehabilitation measures at the earliest stages of childhood diseases; - an individual approach to the preparation of rehabilitation programs, taking into account the characteristics of the course of the disease, the age of the child, the characteristics of his living conditions and upbringing; - continuity, consistency and succession of activities at various stages of rehabilitation with medical supervision of their results; - complexity in the construction of programs, taking into account the use of the entire arsenal of rehabilitation means; - availability of rehabilitation methods; forms and methods of organization should be simple and cost effective; - active and conscious participation of the parents of a sick child in the program of medical rehabilitation; - the final stage of rehabilitation is professional orientation, i.e. the possibility of returning to school, to the children's team. The volume of rehabilitation measures provides for the use of therapeutic nutrition, medications, mineral waters and herbal medicine, physiotherapy and etc. At the first, stationary stage, early and late rehabilitation is carried out. Early rehabilitation is carried out in the specialized department, late - in the rehabilitation department hospital. The main goal of this stage is to stabilize the results of treatment in the acute period. or in the period of exacerbation of the disease, diet therapy, elimination of chronic factors. The second, dispensary-polyclinic, stage provides for a long-term dispensary observation, anti-relapse courses of treatment, determination of the work regimen and life, an annual assessment of the effectiveness of rehabilitation. The organizational basis is departments and centers of rehabilitation treatment in dispensaries The third sanatorium-resort stage consists in the most complete elimination pathological consequences of the disease, restoration of the functional ability of the patient child in specialized sanatoriums. This stage can be carried out in the conditions of a local sanatorium (local and resort areas). Factors of rehabilitation of the sanatorium stage are: sparing - training mode When sending to the sanatorium, the following documents must be issued: 1) a sanatorium card which indicates the diagnosis, objective and laboratory examination, list of past diseases, preventive vaccinations; 2) a certificate from a doctor about the absence of contact with infectious patients; 3) a certificate from a dermatologist about the absence of skin contagious diseases; 4) certificate of the results of the study on diphtheria and dysentery bacteriocarrier. The factors of spa treatment include: mud therapy, balneotherapy, hardening, light therapy, exercise therapy,  There are several types of rehabilitation: 1.Social rehabilitation provides for the provision of a patient (disabled person) with special means of transportation, comfortable additional living space, material assistance, services of a social service center (according to indications). 2. Vocational rehabilitation involves rational employment, labor recommendations, the provision of auxiliary technical means for work at home, etc. 3. Medical rehabilitation, which is carried out by medical workers, since social and professional are not directly related to the medical field. Medical rehabilitation provides for the widespread use and combination of a number of methods impact on a sick person: Ø Psychotherapy (taking into account personal characteristics and psychological attitude). Ø Physical methods (exercise therapy, massage, breathing exercises, physiotherapy proper, etc.). Ø Medicinal methods (first of all, these are pathogenetic agents and agents that activate the body's defenses). Ø Reconstructive and organ-preserving operations. Ø Prosthetics and orthotics (the use of orthopedic devices for biomechanical correction of damaged own limbs). Ø Diet therapy. Ø "Employment therapy" and occupational therapy (so that the patient lies less and “went away” into the disease, and was more actively involved in household, feasible professional activities, communicated with people, etc.).  Medical rehabilitation of chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) - one of the most common pathological conditions in the world, characterized by a high level mortality and high resource utilization healthcare. At the outpatient stage, it is necessary to perform the following non-drug rehabilitation measures: - appointment of a therapeutic regimen, including measures to reduce pollution environment and providing physical activity. To this end, in stage I-II of the disease, it is necessary to convince the patient to engage in physical training, exercise. At any stage of the disease, physiotherapy exercises are indicated with the obligatory using special breathing exercises. The volume and nature of the exercises is selected individually, taking into account the state of the cardio-respiratory system; – prevention of disease progression (smoking control); – conducting educational programs, the purpose of which is to make the patient an active participant in the treatment process. In addition, in the III-IV stage of the disease, it is obligatory a component of rehabilitation measures is oxygen therapy. All of the above methods are implemented in a complex in combination with drug therapy, in the form of a program that takes into account the stage diseases, occupational history, comorbidities and the presence of bad habits. Respiratory rehabilitation, including physical training, clinical nutrition, patient education and rational psychotherapy, according to the American and European Respiratory Societies, leads to numerous positive effects, including improved exercise tolerance, improving health-related quality of life, reduction in the number and duration of hospitalizations, improved survival and long-term preservation of effects after a course of training. At stage I, the leading physical training plays a role, a stage is required sanatorium-and-spa treatment, the regular implementation of which allows for stage I and II of the disease achieve a stable remission without the threat of progression of the process and the transition to more severe forms. izatsiya muscle tone. At stage II, in addition to the indicated rehabilitation measures, it is advisable to include physiotherapeutic procedures that have an anti-inflammatory and resolving effect, according to the methods of local exposure, that is, on the chest area. At stage III of the disease, the exercise therapy methodology changes significantly, and respiratory gymnastics comes to the fore. Emphasis in rehab activities should be transferred to inhalation and respiratory physiotherapy, to which, in addition to oxygen therapy, includes normo- and hyperbaric oxygenation. Diaphragm electrical stimulation, laser therapy, magnetotherapy can give a certain effect. and acupuncture. At stage IV, rehabilitation measures are carried out to a minimum extent and are aimed at reduction of congestion in the lungs. The inclusion of physiotherapy and spa treatment methods in rehabilitation programs helps solve the main problem of rehabilitation treatment to reduce bronchial obstruction and slow down the process of bronchial remodeling. Influence at reversible obstruction due to bronchospasm, swelling of the mucous membrane of the bronchial tree and hypersecretion, have such methods of hardware physiotherapy, as medicinal electrophoresis, especially according to To date, aerosol therapy with nebulizer inhalers are the only physiotherapeutic method, the inclusion of which in the rehabilitation programs of patients with COPD is mandatory. Unfortunately, aerosol therapy is often viewed as method of endobronchial drug administration drugs, not taking into account that during inhalation there is a breathing exercise procedure, and from physical aerosol properties (temperatures, reactions, concentrations) depends on the positive or negative impact on mucociliary clearance. At the outpatient stage of rehabilitation for inhalations, it is advisable to use natural mineral waters (MW), the concentration of which does not exceed 5-6 g/l. mineral waters when taken in the form of inhalations contribute to the improvement of the rheological properties of bronchial secretions and sputum discharge, have local anti-inflammatory action, stimulate local immunity. Most effective for COPD are sodium chloride waters, which, when used inhalation, in addition to local action, cause a general adaptive effect that provides increase in nonspecific resistance of the body. A method close to aerosol therapy is halotherapy - treatment of artificially altered air environment, most often similar to the microclimate of salt mines and karst caves. Speleotherapy is a method of treatment by prolonged stay in conditions of a kind of natural microclimate karst caves, grottoes, salt mines, mine workings of metal, salt and potash mines, has been known since the beginning of the last century. The main active factor of speleotherapy in salt mines is fine aerosol of sodium, calcium, potassium salts and magnesium, which is 80-90% represented by particles less than 5 microns, as well as negative air ions. Inhalation of such aerosols and air ions leads to liquefaction of sputum and accelerates its removal from the airways. ways. At the same time, along with the improvement of bronchial conductivity, mucociliary clearance and blood flow of the respiratory mucosa are restored. Aerosols of salts have a bacteriostatic effect on the microflora of the respiratory tract, preventing the development of the inflammatory process, and the high content of light air ions improves the psycho-emotional state of patients. Adaptation of the body to the specific microclimate of the cave is accompanied by activation of the sympathetic-adrenal system, increased production of To the most effective methods of reducing bronchospasm, normalizing the tone of the muscles of the chest, including including intercostal, includes pulsed electrotherapy. When exposed to the chest, impulse currents (sinusoidal modulated, interference and their analogues) increase the bioelectrical activity of the neuromuscular apparatus, causing relaxation smooth muscles of the bronchi and training the striated muscles involved in breathing. Pelotherapy in the form of mud applications, inductothermy, when administered to the chest cells have a pronounced anti-inflammatory and dissolving action. As a result, there reduction of peribronchial infiltration, which is one of the causes of irreversible obstruction. In recent years, in the treatment of broncho-pulmonary pathology, vibro- thermomagnetic therapy devices have been used, providing combined exposure to alternating and pulsed magnetic fields, vibration and heat. During treatment on such a device in in a short time, relief of inflammation is achieved, drainage and absorbing effects  Medical rehabilitation in cardiovascular pathology. Pathology of the cardiovascular system remains the main cause of death and disability in most countries. Annually from cardiovascular diseases in Russia, 700 people die per 100,000 population, that is, more than 1 million! The main non-pharmacological agents used in rehabilitation and secondary prevention programs for cardiovascular pathology include technologies of physiotherapy exercises, psychotherapy, physiotherapy, clinical nutrition, etc. Physical rehabilitation is the leading type rehabilitation care for all cardiological patients, including those with severe heart failure, regardless of its etiology. The term "physical rehabilitation" refers to the use various forms of physiotherapy exercises and expansion motor activity at home. Systematic physical training influences many mechanisms of development of atherosclerosis and coronary disease. In studies carried out in the 1990s in a number of countries, it has been proven that regular (at least a year) dosed exercise therapy leads to inhibition progression of coronary atherosclerosis and its regression, increase in exercise tolerance and increase in physical performance, a significant decrease in heart rate and systolic pressure. The main methods of rehabilitation of cardiac patients also include psychological and psychotherapeutic assistance, the tasks of which are to form a target setting for a healthy lifestyle. life and correction of the psycho- emotional state patient. One of the most effective behavioral interventions recognized schools for patients with coronary artery disease and hypertension, thanks to which psychotherapeutic assistance becomes available to most patients of this profile. Efficiency psychotherapy can be enhanced by combining with physiotherapy technologies and use computer software. An obligatory component of the rehabilitation program for diseases of the circulatory system is anti-atherosclerotic diet, which is based on the principle of calorie restriction, reducing the content of animal fat, salt and soluble carbohydrates. The diet should include enough quantity of fresh vegetables and fruits, dairy products low in fat and salt, seafood. Most often in rehabilitation treatment of cardiac patients the following methods of hardware physiotherapy are used: drug electrophoresis with galvanic and impulse currents, electrosleep, transcranial electrical stimulation, treatment with an alternating electromagnetic field of the decimeter range (UHF therapy), magnetotherapy, laser therapy, treatment with low-intensity electromagnetic radiation of extremely high frequencies (EHF-therapy). Improving the effectiveness of rehabilitation measures in the pathology of the cardiovascular system can contribute to the use of methods of reflexology. It has been established that a course of stimulation acupuncture points causes an increase in the content beta-endorphins in the blood, a decrease in the vasoconstrictor response to noradrenaline and an increase in endothelium-dependent vasodilation, a decrease in the frequency of arrhythmias in conditions of stress and hypoxia of the heart muscle, activation of antioxidant defense mechanisms, increase resistance of cardiomyocytes to hypoxia.  Principles of Medical Rehabilitation patients with myocardial infarction To the basic principles of medical rehabilitation patients with myocardial infarction: - early start in a hospital during the acute period of MI (first stage); - post-stationary rehabilitation in a specialized rehabilitation center or department of a hospital, local sanatorium (second stage); - maintenance phase of rehabilitation, practically - constant secondary prevention in an outpatient setting, including dispensary observation in the clinic and spa treatment (third stage). The key to the effectiveness of rehabilitation measures is their continuity and succession for various stages of dispensary observation. To the methods of choice in the treatment of coronary disease hearts include laser therapy. The following effects obtained with the course application of low- intensity laser radiation (NLI) of red and infrared bands: - improvement of microcirculation, accompanied by an increase in fibrinolytic activity of the blood, an increase in the concentration of endoheparin, a decrease spontaneous aggregation of red blood cells and a decrease in the rate of platelet aggregation; - antianginal effect; - antiarrhythmic effect due to the activation of metabolic processes in the myocardium and an increase in its electrical stability; - modulating effect on the neuroimmunoendocrine system; - anti-atherogenic effect, manifested by an increase in high-density lipoproteins  Fundamentals of medical rehabilitation of post-stroke sick Basic principles of medical rehabilitation patients after a stroke are early beginning, phasing, continuity, interaction with family, social attitude and multidisciplinary approach to planning and conducting rehabilitation activities. The first stage of rehabilitation is carried out in acute period of cerebral stroke (the first 2-4 weeks from the onset disease) in the conditions of the neurovascular (stroke) department of the hospital. The objectives of this stage are early activation of the patient, prevention of the development of secondary pathological syndromes (contractures, arthropathy) and complications (pressure sores, congestion in the lungs), restoration of elementary voluntary movements. To achieve these goals in intensive care unit can be implemented rehabilitation program including the following Events: – positional treatment, passive-active gymnastics, medical massage; – breathing exercises and inhalation therapy; – physiotherapy with low-intensity physical factors (magnetotherapy, EHF-therapy, deep oscillation with Hivamat); – neuromuscular electrical stimulation; - correction of speech disorders, based on classes with a speech therapist and the use of neuromuscular stimulation on devices such as VocaStim Master; – psychotherapeutic correction. With stabilization of hemodynamics, the initial stages of verticalization, a prerequisite for this is the monitoring of blood pressure and heart rate. The second stage of MR should be carried out in a specialized rehabilitation center (department hospital, local sanatorium) for patients with pathology of the central nervous system, in which work also organized on a multidisciplinary basis. The team includes additionally a reflexologist, a manual therapy doctor. The main task of the second, post-stationary, stage is restoration of impaired functions and development of compensatory mechanisms of the patient's motor activity for his physical and social adaptation. Like at the first stage, the basis of the rehabilitation program is physiotherapy, neuropsychological rehabilitation and, if necessary, correction of speech disorders. Physiotherapeutic treatment is expanding, which at this stage can be not only symptomatic, but also pathogenetic, aimed at correction of hemodynamic and hemostasiological disorders, increased adaptive-compensatory body's capabilities. More actively used occupational rehabilitation, to replenish the motor deficiency methods of reflexology and manual therapy are used. Used to reduce muscle spasticity methods of cryotherapy, thermotherapy and magnetotherapy: Cryotherapy. Ice packs (refrigerants) are placed on the area of ​spastic muscles, up to 3-4 zones per procedure, the duration of exposure to the zone is 1-3 minutes, 2-3 times per procedure with an interval of 3-5 minutes. Magnetotherapy with alternating magnetic field using magnets (magnetic belts). Heat treatment. Applications of paraffin, ozocerite on projection area of ​the spastic muscles of the arm or leg, 48- 50 °C, 20 min, daily or every other day,  Principles of Medical Rehabilitation after operations on the digestive organs. To the main categories of gastroenterological patients in need of medical rehabilitation, include patients after surgery on the stomach and gallbladder, who have a high risk of long-term disability or a persistent decrease in social and household activity up to the formation of disability. The main elements of complex rehabilitation treatment are peloids of various physicochemical composition, physiotherapeutic procedures, climatotherapy, therapeutic gymnastics. Special place in the rehabilitation of patients with pathology of the digestive system, drinking mineral waters (MW) are occupied, having a diverse effect on the gastrointestinal tract (GIT). The main effects of MW include a regulatory effect on the level of intestinal hormones (secretin, pancreozymin, gastrin) with a subsequent change in the level of gastric secretion, secretion of pancreatic juice, bile. Due to direct action contained in MW mineral salts, microelements and gases activity increases redox processes, microcirculation improves and, accordingly, trophic and reparative processes in the gastric mucosa. MV at drinking treatment have a local immunoregulatory effect, stimulate metabolic processes in the liver cell, insulin production, are able to increase or weaken the contractile function of the smooth muscles of the gastrointestinal tract. The severity and direction of therapeutic effects depends on the chemical composition of MW and drinking regime. Properly constructed therapeutic nutrition is important, which, together with the action other factors ensures the achievement of a therapeutic result in patients undergoing  Medical rehabilitation of patients after gastric surgery. Program rehabilitation begins 2-3 weeks after surgery for the purpose of prevention and treatment postoperative complications and functional disorders. Medicinal and non-drug remedies are used to eliminate postoperative inflammation, restore motor- evacuation functions of the gastrointestinal tract, normalization neurohumoral regulation of the functioning of the digestive organs and the body as a whole; as well as improving the functional state of the pancreas and liver. The most widely used methods of physiotherapy in the early postoperative period are as follows methods: 1. Drinking mineral water low or medium mineralization. 2. Novocaine electrophoresis The purpose of the technique: analgesic, trophic and reparative effect, prevention of post-gastroresection disorders. 3. Electrophoresis of 3% and 6% mud extract solution. The purpose of the technique: trophic, reparative action, improvement of motor- evacuation function in post-resection syndromes. Contraindications to mud extract electrophoresis: suppuration of the postoperative wound, non-absorbable postoperative infiltrates, exacerbation of concomitant diseases of the digestive system. 4. Diadynamic therapy or amplipulse therapy on the projection area of ​the stomach stump is transverse, the location of the electrodes is similar to the electrophoresis technique novocaine. The purpose of the technique: analgesic, trophic and reparative effect, prevention and treatment of or 5. Electrosleep dumping syndrome transcranial electrical stimulation. The purpose of the technique: analgesic, reparative effect, improvement of motor- evacuation function, psycho-emotional state. 6. Magnetotherapy The purpose of the technique: anti-inflammatory, trophic and reparative action, improvement of the functional state of the liver and pancreas. Contraindications: severe hypotension, diencephalic syndrome. 7. Laser therapy The purpose of the technique: reparative, analgesic effect, improvement of the psycho- emotional state, moderate improvement in motor-evacuation function, prevention and treatment of anastomotic ulcers, improvement of the functional state of the liver and pancreas, immunomodulatory action. Note: in case of poor wound healing on the area the emerging postoperative scar to additionally act with red laser radiation. 8. UHF therapy The purpose of the technique: anti-inflammatory, trophic and reparative effect, improvement of the functional state of the liver and pancreas, immunomodulatory effect, prevention and treatment of ulcers anastomosis. 9. General baths (appointed with good health): sodium chloride, radon, iodine-bromine, carbonic baths with a water temperature of 36-37 degrees, The choice of baths is dictated by the general condition of patients and the presence of concomitant diseases. The purpose of the technique: improving the functional state of the central and autonomic nervous system, reducing asthenic syndrome, improving the functional state of the gastrointestinal tract, liver, pancreas. Physiotherapeutic methods of treatment are combined with therapeutic exercises and diet therapy  Medical rehabilitation of patients after gallbladder surgery and bile ducts. Critical for preventing postchocystectomy syndrome and beyond rapid return of working capacity has rehabilitation treatment of patients after cholecystectomy with the use of balneological and physiotherapeutic factors. Such treatment is advisable immediately after the end of the surgical stage treatment, that is, 2-3 weeks after surgery. Treatment with spa and physiotherapy factors contraindicated in the presence of residual bile duct stones; stenosis of the common bile duct. Methods and techniques of physiotherapy used in early postoperative period (after 2-3 weeks after operation): 1. Drinking mineral water low or medium mineralization, with a predominance of sulfate ion, magnesium, calcium and sodium ions The purpose of the technique: reduction of lithogenic properties bile, stimulation of the secretion and outflow of bile, improvement of the functional state of the liver and pancreas. 2. UHF therapy The purpose of the technique: anti-inflammatory, trophic and reparative effect, improvement of hemodynamics and functional state of the liver and pancreas glands, immunomodulatory action.  4. Magnetotherapy The purpose of the technique is to improve the blood supply to the liver, decongestant, anti-inflammatory, trophic and reparative action, improvement of functional condition of the liver and pancreas, reduction lithogenic properties of bile. Contraindications: 5. severe hypotension, Transcranial electrical stimulationdiencephalic according tosyndrome. standard methodology. Shown when prevailing in clinical picture of the pain syndrome. The purpose of the technique: analgesic, reparative effect, improvement of the functional state of the liver, psychoemotional state. 6. Electrophoresis of novocaine (platifillin, magnesium, no-shpy) The purpose of the technique: spasmolytic, trophic, reparative action, reduction of lithogenic properties bile and prevention of recurrence of stone formation, improvement of the functional state of the liver. 7. Electrophoresis of a mud solution or galvanic mud with a predominance of trophic disturbances and a slowdown in reparative processes The purpose of the technique: trophic, reparative and anti-inflammatory effect, improvement of the motor-evacuation function of the gastrointestinal tract, the functional state of the liver/ 8. SMT therapy The purpose of the technique is to improve the hemodynamics of the liver, analgesic and anti-inflammatory action, improvement of the motor function of the biliary tract and gastrointestinal tract. 9. Mud applications Contraindications to mud therapy and galvanic mud: common to balneo-mud therapy, pronounced asthenia, subacute pancreatitis, active hepatitis, complications from the heart or lungs in the postoperative period. 10. Laser therapy The purpose of the technique: reparative, analgesic action, improvement of the psycho-emotional state, moderate improvement in the motor-evacuation functions, improvement of the functional state of the liver and pancreas, immunomodulatory action. 11. Shared baths The choice of baths is dictated by the general condition of the patients and the presence of comorbidities. The purpose of the technique: improvement of the functional state of the central and autonomic nervous system, reduction of asthenic syndrome, improvement of the functional state of the gastrointestinal tract, liver, pancreas.  Medical rehabilitation in urological and nephrological diseases. The purpose of the rehabilitation of patients with urological diseases is to reduce the period of disability, improve the functions of body systems and improve the quality of life. Rehabilitation includes methods, aimed at reducing inflammation, improving trophism, restoring the functional activity of the affected pelvic organs. General contraindications to rehabilitation measures include concomitant acute inflammatory and infectious diseases, decompensated somatic and oncological diseases, severe disorders of the intellectual and non-intellectual sphere and mental illnesses that impede communication and the possibility of active participation patient in the rehabilitation process. Cystitis is an inflammation of the lining of the bladder bladder, accompanied by a violation of its function. The main syndromes of acute cystitis: inflammatory, pain, dysuric, dysmetabolic. Treatment of chronic cystitis is aimed at eliminating violations of the reservoir function of the bladder, intensifying its bioenergetic processes. walls, creating the maximum concentration of antibacterial drugs in the focus of inflammation; Physical methods of treatment are prescribed from the first days of illness and for the relief of inflammatory and dysuric syndromes, achieving an analgesic effect and restoring urinary urodynamics ways Analgesic methods: Diadynamic therapy gives an analgesic effect for due to the impact of impulse suppression in the fibers pain sensitivity. Muscle relaxant methods: Heat therapy. Due to the thermal action in the area paraffin and ozocerite applications reduce spasm smooth muscles. Diuretic methods Drinking mineral waters (low-mineralized, sulfate, chloride, sodium-calcium containing organic substances). Pyelonephritis is a non-specific inflammatory the process of the kidney, its pelvis and calyces, proceeding with predominant lesion of the interstitial tissue kidneys. In patients with pyelonephritis, syndromes are distinguished: inflammation of the renal pelvic system, immune dysfunction, hemodynamic and metabolic disorders; astheno- neurotic. Physical methods of treating patients are aimed at relief of inflammation (anti- inflammatory methods), enhancement of reparative regeneration (reparative- regenerative methods), improvement of microcirculation and metabolism in the kidneys (vasodilating methods), activation of glomerular filtration and urination (diuretic methods) and correction of immunity disorders (immunostimulating methods). Anti-inflammatory methods: UHF therapy, DMV-therapy, drug electrophoresis of uroseptics Reparative-regenerative methods: infrared laser therapy, ultrasound therapy Vasodilating methods: ozokerite, pelotherapy, infrared irradiation, galvanization, low- frequency magnetotherapy. Galvanization. Direct current activates blood flow in the renal parenchyma stimulates the formation of biologically active substances (bradykinin, kallikrein, histamine). Increased blood and lymph flow, along with an increase in the resorption capacity of tissues, leads to reduce inflammatory edema of the renal tissue, stimulates metabolic- Diuretic methods: high-frequency magnetotherapy, pulsed magnetotherapy, mineral water drinking waters with organic substances, interference therapy, sodium chloride baths. Interference therapy - causes rhythmic contractions of vascular smooth muscles, renal pelvis and ureters, which leads to an increase in their blood supply, lymphatic drainage, oxygen supply to the tissue kidneys, elimination of tissue hypoxia, increased intensity of tissue respiration and enzymatic reactions, improved trophism. Immunomodulatory methods: UV irradiation in suberythemal doses, heliotherapy, thalassotherapy, blood irradiation with laser radiation, radon baths. Laser irradiation of blood. Monochromatic radiation selectively activates molecular complexes of blood plasma (photobioactivation), immunogenesis and metabolic processes in tissues, reduces the rate platelet aggregation, fibrinogen content, increases the amount of free heparin. Medical rehabilitation for injuries and diseases of the musculoskeletal system. The purpose of rehabilitation of patients with diseases musculoskeletal system is to prevent disability, improve the functions of body systems and reduce pain. Rehabilitation includes methods, aimed at maintaining joint stability, coordination of movements, muscle strength, as well as preventing subluxations and deformities of the joints. Optimal for restorative treatment of patients is the elimination or full compensation of damage. However, this is far from always possible, and then life should be organized the patient in such a way as to exclude the influence of an existing anatomical or functional defect (for example, by using orthoses, auxiliary household devices). General contraindications to rehabilitation measures include concomitant acute inflammatory and infectious diseases, decompensated somatic and oncological diseases, severe disorders of the intellectual and non-intellectual sphere and mental illnesses that impede communication and the possibility of active participation patient in the rehabilitation process.  Bruises A bruise (contusion) is a closed mechanical damage to tissues without violating the integrity of the skin, which occurs under the influence of a short-term effect of a traumatic factor. The main syndromes: pain, edematous, functional disorders of the motor and sensory spheres, limited hemorrhage (hematoma). Physical methods of treatment in the early stages are used to stop the hemorrhage (vasoconstrictor methods), pain relief (analgesic methods), edema restrictions (lymphatic drainage, vasodilating methods). With extensive bruises and hematomas apply methods for resolving developing aseptic inflammation (anti-inflammatory methods), prevention of the formation of pathological scars (fibromodulating methods). Physical methods: 1. Analgesic methods: local cryotherapy, electrophoresis of anesthetics, UV irradiation in erythema doses, diadynamic therapy, amplipulse therapy, interference therapy, diadynamic and amplipulsforesis of local anesthetic drugs. Local (batch) cryotherapy. Under the influence of the cold factor, the excitability of pain and tactile fibers with a subsequent block of their conduction. Coming 10 minutes after the start of the procedure muscle relaxation reduces pain caused by reflex muscle spasm In addition to the analgesic effect, it helps to stop hemorrhage, gives a decongestant effect. Cryoagents are used (ice, water, ether, ammonium nitrate, liquid nitrogen, chloroethyl), with which cotton swabs are moistened, various containers are filled (bubbles, cryopackages, applicators) or spray these products through a spray bottle. 2. Vasoconstrictive method: cooling compress. Cold (cooling) compress causes constriction vessels of the superficial and deep vasculature of the skin, to a lesser extent - skeletal muscles, followed by cessation of hemorrhage into soft tissues. The use of a compress also causes local anesthesia of superficial tissues. 3. Lymphatic drainage methods: alcohol compress, massotherapy. Alcohol compress causes tissue dehydration for by increasing the osmotic pressure in the area where the compress is placed with the activation of the exit of liquid from interstitial tissue into lymphatic capillaries. Massotherapy. Mechanical effects on the affected area cause the expansion of superficial and deep vessels, stimulate blood flow and lymph flow through the surrounding lymphatic vessels (mechanical lymphatic drainage). 4. Vasodilating methods: infrared irradiation, magnetotherapy, warming compress infrared irradiation. A decrease in the tone of capillaries and arterioles is caused by heating of the irradiated tissues at a depth of up to 5 cm. Activation of the microcirculatory channels and increased vascular permeability contribute to removal of cell autolysis products from the focus, reduction of edema (draining and dehydrating effects). Increased differentiation of fibroblasts and degranulation of monocytes leads to the activation of proliferative processes at a later date after injury (from the 4th-5th days). Low-frequency magnetotherapy causes in the blood and lymph, magneto- hydrodynamic and magnetoelectric forces that enhance local blood flow, reduce adhesion and aggregation of platelets, reduce congestive hyperemia, microthrombosis of blood vessels and swelling. A warming compress is placed for 6-8 hours. Room temperature. Possibility of reapplying the compress after 2-3 hours. Carry out within 3-4 days. Local fresh baths cause heat flow inside tissues with excitation of thermomechanosensitive structures with a pronounced vasodilating reaction, an increase in the permeability of the vascular wall and an increase in lymphatic drainage, which leads to a decrease in tissue edema. Removal of muscle spasm and utilization of algogenic mediators reduces the pain component of the clinical picture of injury. 5. Anti-inflammatory methods. In the first days (2-5 days - depending on the intensity of the degree of aseptic inflammation), given the presence of congestive hyperemia, pronounced activation of various vasoactive components (acid lysosome proteases, bradykinin, histamine, kallikrein, prostaglandins, etc.) with a corresponding increase in endothelial permeability, it is inappropriate to use heat exposure methods that can aggravate swelling and pain. To eliminate inflammation, it is necessary to stop congestive hyperemia, reduce the activity listed vasoactive substances, permeability endothelium, increase the phagocytic activity of macrophages and leukocytes, create conditions for better drainage of the injury area. Contraindications to physiotherapy for soft bruises tissues: continued heavy bleeding, purulent inflammation (purulent hematoma, phlegmon, abscess) before opening and manifestation of intoxication.  Osteoarthritis Osteoarthritis (OA) is a chronic progressive non-inflammatory disease of peripheral and/or central (vertebral) joints with destruction of the articular cartilage and degenerative changes in the epiphyses of the articulating bones, with the formation of subchondral bone cysts and marginal bone growths. Physical methods of treatment are aimed at stopping periodic and short-term pain that occurs with a significant load on the joint or its prolonged immobility (analgesic methods), relief of antigen-induced inflammation (anti-inflammatory and reparative-regenerative methods) and the resulting locomotor dysfunction (methods for correcting locomotor dysfunction), as well as restoration of metabolic disorders and synthetic activity of chondrocytes (trophostimulating methods). Physical methods of treatment of patients with osteoarthritis: 1. Analgesic method: UV irradiation in erythemal doses. To achieve an analgesic effect in OA the use of UV irradiation is proposed. It's believed that irradiation of the pain zone in erythemal doses leads to the creation of photodegradation products that cause the formation of immunoglobulins A, M, E and others compounds that regulate the tone and permeability of skin vessels. As a result, in the adjacent layers of the skin and vessels, the formation of biologically active substances This leads to the formation of erythema, an increase in perineural edema and compression. nerve conductors. The parabiosis of skin afferents that occurs in the area of ​irradiation spreads along throughout the fiber and blocks impulses from the pain hearth. Activation of the mechanosensory field of the skin by photodestruction products causes an intense flux afferent impulses in the CNS, which weakens central internal inhibition and delocalizes the pain dominant. Low frequency alternating magnetic field reduces pain and limitation of knee joint function, caused by osteoarthritis. Interestingly, long-term (at least 2 weeks) wearing of magnetic bracelets and knee pads reduce knee pain in OA, however, further studies are needed to study the mechanism of this effect. Transcutaneous electrical nerve stimulation is effective for reducing pain in osteoarthritis of the knee. An analgesic effect can also be obtained, using sinusoidal modulated currents. They cause a rhythmically ordered flow of afferent signals in the CNS, which suppresses impulses from the pain focus, they block the peripheral conductors of pain sensitivity, up to their parabiosis, and also effectively affect pain lesions located in deep tissues of the musculoskeletal system 2. Anti-inflammatory methods: low-intensity UHF therapy, high-intensity centimeter wave therapy, infrared laser therapy. Infrared laser therapy. Infrared laser radiation is selectively absorbed by molecules nucleic acids and oxygen, induces reparative tissue regeneration and enhances their metabolism. With infrared laser irradiation of borderline stimulation occurs with the focus of tissue inflammation fibroblasts. Formed by the absorption of energy laser radiation products of denaturation of proteins, amino acids, pigments and connective tissue act as endogenous inducers of reparative and trophic processes in tissues, activate the maturation of granulation tissue on the irradiated surface. High intensity centimeter waves pronounced thermal effect on articular and periarticular tissues. By increasing the speed blood flow, the number of functioning capillaries and dilatation of small vessels increases regional hemodynamics and lymph drainage, diffusion processes and permeability. This improves the blood supply to the cartilage, helps to reduce the focus of exudation in the synovial shells. 3. Reparative-regenerative method: high-intensity high-frequency magnetotherapy 4. Fibromodulatory methods: ultrasound therapy, hydrogen sulfide baths, radon baths, pelotherapy, infrared laser therapy. Ultrasound therapy improves metabolism and blood circulation in the joints and periarticular tissues, relieving tension in the muscles of the limbs, increasing their trophism and strength, resorption exudate in the joints, reducing pain and stiffness movements. Ultrasonic vibrations increase the activity of lysosomal cell enzymes, which leads to to the purification of the inflammatory focus from cellular detritus and pathogenic microflora. local extension vessels of the microvasculature leads to an increase in volumetric blood flow in weakly vascularized tissues by 2-3 times, increasing the degree of their oxygenation and metabolic rate. Activation of membrane enzymes by ultrasonic vibrations and depolymerization of hyaluronic acid lead to resorption swelling in the affected joints or their reduction, reduction of compression of nociceptive nerve conductors in the affected area. Ultrasound selectively increases blood flow and raises temperature by one degree at the border of dissimilar articular tissues. As a result, their elasticity increases, heating of the tissues of the joint reduces the conductivity of the thermomechanically sensitive structures of the tendons and ligaments, which results in less joint pain and muscle spasm. With severe pain, medication may be administered (baralgin, hydrocortisone, ointments with NSAIDs, etc.) using ultrasound. tolerability of direct current and in the presence of pathology from the cardiovascular system. 5. Trofostimulating methods: diadynamic therapy, interference therapy, local darsonvalization. 6. Physiotherapy exercises are used both during the period of exacerbation and during the period of remission. Physical exercise reduces pain and improves joint function in patients with osteoarthritis, and also promotes prevention or elimination of atrophy of the periarticular muscles. Dynamic aerobic exercise types have also proven to be effective in improving joint and gait function, reducing pain syndrome, and also increases the functional abilities of the patient. The method of exercise therapy depends on the period of the disease. Acute period: improvement of local blood and lymph circulation; relaxation of pathologically tense muscles; general tonic effect on the patient. Therapeutic exercises are prescribed for 3-5 days with a decrease in pain. Starting positions are selected depending on the location of the lesion (upper or lower limb). For the affected joint, it is recommended to change the flexion and extension position in during the day. Use relaxation exercises muscles, free dynamic exercises in distal joints. Subacute period: with a decrease in pain to tasks the previous period, exercises are added: to normalize the muscle tone of the limb; and to increase range of motion in the affected joint (with I-II stages OA). Of the special exercises, light, free and swing movements in the affected joint are used, performed until slight pain appears. Each the exercise is repeated many times. It is Remission period: strengthening of muscle groups adjacent to the joint; recovery (with stage I-II OA) or maintaining the achieved range of motion in the affected joint; increasing the overall physical performance of the patient; weight reduction body; normalization of posture and walking. Therapeutic exercises are performed in optimal conditions for affected joints starting positions. You can use exercise bikes and mechanotherapy devices. Swimming is shown. Basic rules for the use of exercise therapy for osteoarthritis: physical exercises must be carried out without static loads on the joint (in prone, sitting, in the pool); movements are performed slowly, with a gradual increase in load (pain should not be overcome); duration of classes - 30-40 minutes. per day (10-15 minutes 3 times a day). 7. Massage in OA favorably affects the neuromuscular apparatus, activates peripheral blood circulation, improves trophism of joint tissues, and helps strengthen muscles. Massage is usually prescribed on the area of ​the affected limb or spine, combined with exercise therapy. 8. Sanatorium treatment. Patients with osteoarthritis on the background of metabolic and functional disorders endocrine glands with secondary synovitis and without it, they are sent to balneotherapy and mud treatment resorts. 9. Balneotherapy has a positive effect on metabolic processes, cartilage metabolism, peripheral hemodynamics and microcirculation in the early stages of OA (stages I-II). In addition, balneotherapy has a beneficial effect on the nervous, cardiovascular, endocrine system, contributing to the formation compensatory-adaptive reactions. Sulfide waters increase cellular metabolism. Under the influence of sulfide baths, the excretion of hydroxyproline in the urine decreases, the content of hexosamines and increased serum acid phosphatase activity blood, which indirectly indicates an improvement in the exchange of collagen fibrils and the main interstitial connective, bone and cartilage tissues and other elements of the joint. While taking sulfide free hydrogen sulfide present in water dissociates into hydrogen ions, hydrosulfite ion and sulfur. Hydrogen sulfide, due to the activation of polymorphocellular mononuclear cells, stimulates reparative regeneration and regulates the structure of collagen fibers in scars. In addition, sulfur ions stimulate mitotic activity of hepatocytes and inactivation toxins by the microsomal fraction of P450 cytochromes, which leads to increased synthesis of proteins and glycoproteins. Free sulfur and its compounds (sulfides) block citrochrome oxidase, lipase, inhibit cellular respiration, the pentose cycle and the synthesis of low-density lipoproteins, which have a pronounced atherogenic action. Sulfides, being included in the metabolism of mucopolysaccharides, utilize chondroitin sulfuric acid. Hydrogen sulfide causes accumulation of biologically active substances and mediators in superficial tissues. The initial short-term vasospasm is replaced by their continued expansion. Impulse activity of nerve conductors of the skin by the end of the procedure decreases, which leads to a decrease in pain and tactile sensitivity. Thus, hydrogen sulfide baths improve blood circulation and trophic processes in the tissues of the joints, promote growth and the normal functioning of synovial villi that secrete synovial fluid, have a positive effect on the state of the muscular system. Radon baths cause an increase in the permeability of the walls of blood vessels and an increase in the migration of polymorphonuclear leukocytes to the focus of inflammation. with the release of collagenase and other enzymes by them, which determines its expediency in case of hyporeactivity. This leads to the activation of collagenase, which resorption of foci of sclerosis in the synovial membrane. Radon alpha radiation reduces the conductivity of unmyelinated nerve conductors, which leads to decrease in pain sensitivity. Radon baths cause a short-term spasm, and then a prolonged expansion of arterioles and a slight decrease in venular outflow, resulting in skin hyperemia. Coming under the influence of radon baths improve blood circulation, microcirculation in synovia and bone metaphysis increases metabolism in the epiphyseal cartilage and eliminates hypoxia and impaired metabolism that have developed in chondrocytes and connective tissue reticulum. As a result, cartilage resistance increases, its function improves, as well as the vital activity of the entire joint, and the inflammatory reaction of the synovial membrane decreases. Radon baths in patients with OA cause a pronounced decrease in the activity of acid hydrolases and proteoglycan-like compounds in blood serum, contribute to the reduction of destructive phenomena in the epiphyseal cartilage and an increase in 10. Therapeutic mud stimulates anabolic and inhibits catabolic processes in the tissues of the joints, improves the supply of cartilage with nutrients and energy. The therapeutic effect of mud is due to an increase in the level of steroid formation and activity sympathetic-adrenal system, which has a normalizing effect on the body's immune reactivity (prescribed for hyporeactivity to optimize hormonal background), its adaptive capabilities and neurotrophic processes. Changes in clinical the course of OA is accompanied by a decrease in the urinary excretion of hydroxyproline, the content of hexosamines in the blood serum and the activity of acid phosphatase, which indirectly indicates an improvement in the exchange of collagen fibrils and the main interstitial substance of the connective tissue of the bone-cartilaginous system and other elements of the joints. Mud treatment, enhancing metabolic processes thiamine and its coenzyme form, significantly increases the patient's need for this vitamin, therefore, during the treatment with peloids of a patient with deforming osteoarthritis, it is advisable to prescribe cocarboxylase, since in this pathology there are profound disorders of thiamine metabolism.