The Use of Non-drug Methods in the Rehabilitation of Patients with Post-thrombophlebitis Syndrome

Introduction, Objectives, and/or Purpose: Stage-by-stage medical rehabilitation is prescribed for all patients with post-thrombophlebitis syndrome (PTS). The development of complex non-drug methods of rehabilitation of patients with PTFS is an important medical and social problem.
The aim of the study was to study the clinical efficacy and identify the mechanisms of action of non-drug complex treatment of patients with PTS of the lower extremities using supra venous laser radiation, low-frequency magnetic therapy, dry-air carbon dioxide baths and structured medical gymnastics in the gym.

Methods: Material and methods. 60 patients with PTS of the lower extremities (CVI C4-C5 according to the CEAP clinical classification) were under observation. All patients were randomized into two following groups: group 1 (main, n=30) received a complex including exposure to supra vascular infrared laser irradiation of blood in pulsed mode through matrix emitters on the popliteal region; pulsed magnetic therapy with induction of 10mTl on the lower extremities using inductors-solenoids; dry-air carbon dioxide baths, as well as structured medical gymnastics in the gym under the supervision of a physical therapy instructor; group 2 (control, n=30) received standard elastic compression (2-3 compression classes) against the background of taking lympho-phlebotonics (a combination of diosmin and hesperidin) and medical gymnastics in the gym. The duration of treatment was 2 weeks (for a course of 10 consecutive daily procedures).

Results: Results. After the course of treatment, the patients of the main group showed a reduction in heaviness in legs, a decrease in the malleolar volume from 26.34± 0.78 cm to 24.26± 0.44 cm (p < 0.05). There was an improvement in the quality of life (QOL) on the CIVIQ 2 scale: on the pain scale by 8.7% (p < 0.05), on the physical scale by 6.1% (p < 0.05), on the psychological scale by 11.5% (p < 0.05), on the social scale by 10% (p < 0.05). Positive dynamics was established in the microcirculation system (MC), which was confirmed by the data of laser Doppler flowmetry (LDF) on the “LAAK-02” apparatus (“ЛААК-02”, Russia). After treatment, a decrease in the initially increased myogenic and neurogenic tone of arterioles was observed in patients with spastic-stagnant type of microcirculation. Congestion in the venules decreased. In patients with hyperemic-stagnant type of MC, the initially reduced tone of arterioles increased, which contributed to the improvement of blood flow in the capillaries. There was also a decrease in stagnation in the venules of the microcirculatory bed. There were no significant changes in clinical and instrumental parameters in patients of the control group during the follow-up period.

Conclusion(s): Conclusion. The proposed non-drug rehabilitation complex for patients with PTS, including laser exposure according to a general technique, pulsed magnetic therapy and dry-air carbon dioxide baths, has a multifocal effect on various links in the pathogenesis of PTS. As a result of treatment, a pronounced correction of microcirculatory disorders was noted: a decrease in the initially increased myogenic tone of arterioles, indicating the removal of obstacles to blood flow in the precapillary link of microcirculation. An increase in the amplitude of endothelial oscillations against the background of a decrease in myogenic tone contributed to an increase in the initially reduced microcirculation index.