Vertebral artery syndrome with cervical osteochondrosis treatment. Treatment of dizziness in cervical osteochondrosis

The most important nerves and vessels connecting the brain with the whole body pass through the neck. Therefore, cervical osteochondrosis is characterized not only by neurological or visceral symptoms, but also by cerebral ones. Long-term problems with blood supply are fraught with ischemic brain disease. And although the vertebral arteries supply approximately 15% of the blood volume to the posterior parts of the brain, and 85% comes from the carotid arteries, deterioration cerebral blood supply from the vertebrobasilar area can lead to serious disorders, such as dizziness when cervical osteochondrosis.

Common cause dizziness may be caused by an unsuccessful night position during sleep: a pillow that is too high compresses the vertebral artery and reduces blood flow. In this case, not only dizziness appears, but also the following symptoms:

darkness or fog before the eyes
visual and auditory disorders
noise in ears

Vertebral artery syndrome

Another common cause of dizziness is vertebral artery syndrome (Barré-Lieu syndrome)..

The spinal canal in the cervical region is narrow, so canal stenosis (narrowing) leads to:

to compression of nerves and blood vessels
spasm of the vertebral artery (due to irritation of Frank's sympathetic nerve)

The culprits of canal stenosis and spasm of the vertebral artery may be

Overgrown osteophytes
Deformities of the lateral hamate vertebral processes cervical region(uncovertebral syndrome)

Clinical symptoms of vertebral artery syndrome

With spasm of the vertebral artery, the following symptoms are observed:

Throbbing pain, usually on one side, in the form of burning jabs in the back of the head, temporal and superciliary parts
Hypertension, tachycardia
Nausea or vomiting
Feeling of pain and burning in the eyes, blurred vision
Deterioration of hearing, appearance of extraneous noise in the ears
Impaired coordination of movements
Opportunity sudden loss consciousness during sudden movements and turns of the neck

Vegetovascular dystonia (diencephalic syndrome)

Osteochondrosis of the cervical spine is accompanied not only by dizziness, but also vegetative-vascular dystonia associated with endocrine trophic disorders.

One of the types of such dystonia can be diencephalic syndrome, which is based on the pathology of the hypothalamus - a part of the diencephalon, which, together with the pituitary gland, is essentially the neuroendocrine center of the brain, responsible for the production of essential hormones and connecting endocrine system with nervous

Poor blood supply and impaired protein metabolism lead to insufficiency of the functions of the hypothalamus-pituitary gland and diencephalic syndrome.

Symptoms of diencephalic syndrome

Symptoms of autonomic vascular trophic disorders:

Neck pain
Feeling of coldness in the extremities, sweating
Increased heart rate and high blood pressure
Heart pain and arrhythmia
Increased irritability and fatigue
Insomnia and bad mood
Gastrointestinal disorders

The cause of dizziness is vestibular-stem syndrome

And finally, osteochondrosis of the cervical spine can cause dizziness due to the so-called vestibular-trunk syndrome. The reason lies in the lack of blood supply to the vestibular apparatus, which is responsible for balance.

The main symptoms of vestibular-trunk syndrome:

Severe dizziness (including vomiting) with any change in head position:
leaning back, turning left and right, even lying down when turning on the other side

Truly, cervical osteochondrosis is very dangerous disease, which opens the gates for many diseases through the brain.

Treatment of dizziness with cervical osteochondrosis

When examining osteochondrosis, the most important thing is considered Doppler ultrasound(USDG) of extracranial vessels. However, such examination today is mainly used for carotid arteries, but for vertebrates it is not fully realized. More accurate is magnetic resonance angiography (MRA) of the vertebral arteries.

In the treatment of cervical osteochondrosis, especially with cerebral syndrome, necessarily include vasodilators and drugs that restore normal cerebral circulation and oxygen supply to the brain. This is the main specificity of treatment

Drugs used in treatment:

Piracetam, Actovegin, aminophylline, Cerebrolysin
Vitamin C, retinol and others

However, treatment aimed at improving brain activity, will not eliminate the very reasons that caused the artery spasm. To minimize them, the same treatment methods are used as in general for cervical osteochondrosis:

Massage
Physiotherapeutic methods:
- Vacuum therapy
- Magnetic therapy
- Exogenous bioresonance therapy

To treat neck pain and relieve muscle and artery spasms, the following are used:

NSAIDs, muscle relaxants in the form of tablets and injections
If necessary, novocaine blockade is performed
For the cervical-collar area, external agents are used:
Ointments, gels,
Great importance plays a role in the treatment of cervical osteochondrosis
Yoga also helps

With vegetative-vascular dystonia, you often have to consult a psychotherapist.

If you experience frequent dizziness with cervical osteochondrosis, then you definitely need to sleep on.

Spinal diseases, like any other disease, if ignored, can transform into severe forms. One of these complications is vertebral artery syndrome with cervical osteochondrosis, the treatment of which may differ in different situations.

The syndrome manifests itself as degenerative changes cervical spine. The main symptom is considered to be severe headache caused by vertebrogenic pain syndrome. Pain in this case occurs due to pinching of the vertebral artery, as well as the nerve plexus enveloping it. The disease can progress quite quickly and can affect even a young body.

IN healthy condition blood circulates freely through the arteries of the spine. Through cervical vertebrae There is a blood supply not only to the cervical region, but also to the brain. In case of damage to the spinal canals, blood circulation is disrupted, which leads to osteochondrosis. If treatment is not carried out in time, the disease begins to develop into severe forms.

The main causes leading to vertebral artery syndrome:

Signs of the syndrome

The symptoms of the disease are varied and are somewhat similar to the signs of cervical osteochondrosis, but, in general, there are differences. Pinched arteries can be either unilateral or bilateral. The severity of the disease depends on this.

The following symptoms are possible with artery syndrome:

severe sudden headaches that occur when turning the head. They can appear either in attacks or be long-lasting;
loss of hearing on the affected side;
dizziness that appears during intense movements;
deterioration in visual acuity and the appearance of “floaters” in front of the eyes due to disruption of adequate supply to the eyes necessary substances;
temporary loss of consciousness;
deterioration of skin sensitivity on the affected side;
feeling of a lump in the throat, slight coughing.

The level of symptoms may vary depending on the extent of arterial damage.

Diagnostic methods

Below are ways to diagnose the disease by a neurologist or therapist.

based on the patient’s complaints;
MRI is a machine that provides detailed images of soft tissue and bones. Allows you to give a reliable picture of possible damage;
Ultrasound of the cervical vessels and brain area. Thanks to this functional method, it is possible to obtain an accurate picture of the structure of the arteries;
diagnostics using radiography. Provides accurate data about possible availability pathological increase in bone mass or changes in the body of the cervical vertebrae.

After consulting a doctor and receiving the necessary recommendations, you will need to undergo a complete diagnostic examination. If the diagnosis is confirmed, it will be necessary to perform a long course of complex treatment of vertebral artery syndrome with cervical osteochondrosis, including the following:

Medicinal treatment method

Depending on the causes of the disease, the attending physician prescribes specific medications. Below are the main ones:

to normalize blood circulation in the brain is prescribed vinpocetine or Cavinton;
in case of dizziness - betahistine or a drug with a similar effect;
to remove inflammatory process used in the cervical spine diclofenac or indomethacin, as chondroprotectors – chondroitin sulfate, hyaluronic acid;
Statins are prescribed to lower cholesterol levels - atorvastatin or rosuvastatin;
to improve and restore metabolism, they are most often prescribed vitamins, nicotinic acid, courses of B vitamins;
if necessary, the therapist can prescribe antidepressants.

Very often, depending on the prescribed medications, treatment courses can last up to 2-4 months.

Exercise treatment method

Without physical exercise indispensable in the treatment of osteochondrosis and artery symptoms. Without such courses, muscles, ligaments and joints begin to weaken, which leads to degradation of the damaged area of the body.

When performing any physical exercise, you must adhere to the basic rules:

Physiotherapy method

Physiotherapy is prescribed in parallel with a course of medications. This way the best result is achieved. The following best practices are:

acupuncture (about it in detail);
hardware stimulation is prescribed on an individual basis;
manual influence in the form of massage of the back, neck and head (details).

Lifestyle changes

To strengthen the chosen course of treatment, it is recommended to change your daily habits. To do this you will need:

Surgical method of treatment

This is a last resort method, which is used in the following cases:

if there is a tumor in the cervical region that interferes with normal circulation;
when intervertebral hernia cervical spine, if therapeutic methods have not brought results.

Vertebral artery syndrome – serious illness, the treatment of which is best carried out on early stages manifestations. To do this you just need to contact a good specialist and undergo examination.

One of the most painful and dangerous pathological processes in the spine is vertebral artery syndrome with cervical osteochondrosis, the symptoms of which are difficult to confuse with any other disease. However, to be completely sure of the correct diagnosis, you should certainly consult a competent doctor. Timely and correct treatment V in this case are the main factors for significantly improving the quality of life.

Recognize vertebral artery syndrome in cervical osteochondrosis in time and begin its treatment without delay. Advanced pathology in which the artery supplying the brain is pressed, including occipital part and cerebellum, provokes the development coronary disease and cerebral stroke.

Of course, an accurate diagnosis requires a series of examinations by the attending physician. However, for preliminary self-control, the patient should pay attention to general state your body. Vertebral artery syndrome with cervical osteochondrosis has the following symptoms:

practically constant feeling migraine-like pain, aggravated not only by physical activity, but also during any body movements;
hearing impairment is most often accompanied by noise in one ear, as well as partial deafness;
significant disturbances in the functioning of the vestibular apparatus, in which during sudden movements the appearance of severe dizziness up to the loss of a foothold;
the occurrence of vision problems accompanied by loss of sharpness, “spots” in the eyes and pain;
problems with work of cardio-vascular system manifested by tachycardia, persistent increase blood pressure and arrhythmia;
autonomic dysfunction nervous system. Appears as constant feeling thirst, hunger and feeling hot;
the occurrence of Claude Bernard Horner syndrome, in which the reaction is most often slowed down eyeball when lighting changes, ptosis appears;
difficulty swallowing;
severe nausea, leading to vomiting;
sudden loss of consciousness.

If a visit to the doctor is delayed, cervical osteochondrosis, manifested as vertebral artery syndrome, is complicated by a transient ischemic attack. This phenomenon provokes the occurrence of frequent pathological conditions in the form of nausea, vomiting, high blood pressure, constant weakness and pressure loss. Movement and movement disorders may also be systematically observed. sensory functions body.

Migraine

Cervical migraine with vertebral artery syndrome can have absolutely any type of manifestation. However, its distribution occurs from the back of the head to the temples. Often, in a certain position of the head, the pain can completely disappear, but with almost any movement it increases.

One of the most striking symptoms of the disease is the fact that pain is always felt when palpating the vertebrae located in the neck area. Migraine attacks themselves can last from a few minutes to a couple of hours.

Dizziness

This sign of vertebral artery syndrome most often appears after sleep, or any long rest in a horizontal position. Often the occurrence of dizziness increases when using high pillows under the head.

In the presence of similar symptom, determining the exact type of disease occurs using. In the case where its use helps eliminate this symptom, the patient is diagnosed with vertebral artery syndrome against the background of cervical osteochondrosis.

Hearing problems

Most often, when noise occurs in one ear, the pathology is observed on that side. The period of remission of the disease is accompanied by slight low-frequency noise. However, immediately before the onset of a new attack, the noise intensifies many times over.

One of the main features of this symptom in vertebral artery syndrome is an increase in the intensity of noise at night, as well as in the hours before morning. In this case, the intensity of the resulting noise varies depending on the position of the patient's head.

Loss of consciousness

Loss of consciousness when vertebral artery syndrome occurs against the background of cervical osteochondrosis is the cause of prolonged pinching of the artery. Most often, this phenomenon occurs when holding the head for a long time in an overextended state.

A signal for imminent loss of consciousness is the manifestation of any of the pathological factors in the form sudden dizziness, partial numbness of the face, temporary blindness of one eye.

Effective methods of treating the disease

Vertebral artery syndrome with cervical osteochondrosis requires compulsory treatment. And to minimize the risk of developing serious pathologies, it is necessary to select and begin treatment in as soon as possible. With this type of disease the patient needs complex treatment, which includes the following methods and means:

reception medicines;
visiting an exercise therapy and physiotherapy room;
receiving therapeutic massage.

In the case where the intensity of the disease does not allow it to be effectively cured with medications, it is used surgical intervention. However general point, which includes the treatment of vertebral artery syndrome with cervical osteochondrosis of any complexity, is the need to systematically wear a Shants collar.

Medications

The main and very first action in the treatment of vertebral artery syndrome against the background of cervical osteochondrosis is taking painkillers and anti-inflammatory drugs. Most often used for this purpose medicines based on ibuprofen. The main drugs in this case are Nimesulide, Nurofen, Ibuprofen and Celebrex.

In addition to eliminating pain and relieving inflammation, with complex treatment this drug The following types of means are used:

venotonics that increase blood circulation. The most effective are products based on troxerutin and diosmin;
means of neuroprotective therapy. These include Gliatillin, Slmazina, Sermion;
antihypoxants, which make it possible to optimally bring the saturation of all brain cells with necessary substances closer to the norm;
neurometabolic stimulants that help the brain and all its parts increase resistance to various negative factors;
auxiliary medications to relieve dizziness, nausea and vomiting.

However, due to the characteristics of each organism, the exact medications and regimens for their administration in the treatment of vertebral artery syndrome that occurs against the background of cervical osteochondrosis must be prescribed by a doctor.

When selecting specific drugs, they must take into account the presence of individual intolerance to any component of the drugs, as well as the degree of development of the disease and the presence of associated pathological factors and symptoms.

Exercise therapy and physiotherapy

Physical education is quite important in the treatment of such diseases as vertebral artery syndrome against the background of cervical osteochondrosis. However, incorrect execution of exercises, as well as incorrect selection of them, can not only be useless, but also seriously harm. Therefore, the main condition for exercising in a physical therapy room is the safety of the exercises, which requires a mandatory stop if a serious feeling of discomfort occurs. The main type of exercise during the treatment of this disease is slow head tilts and slight loads on the neck muscles.

Physiotherapy, including the use of electrophoresis and magnetic therapy, requires mandatory exclusion by a doctor possible contraindications. And the continuous duration of treatment usually does not exceed 6 sessions. In some cases, acupuncture is used on patients to relieve muscle spasms.

Massotherapy

The main purpose for which it is used massotherapy with this type of disease, maximum muscle relaxation is achieved. This allows you to significantly reduce the pressure on pinched vessels and ensure normalization of blood flow.

The main condition that must be met during a therapeutic massage is the softness and accuracy of all movements. Also, for the safety of the patient’s health, therapeutic massage should be performed only by a qualified physician.

Effective treatment of a disease such as vertebral artery syndrome against the background of cervical osteochondrosis requires a lot of time before the first symptoms appear. positive results. And in order for recovery to occur as quickly as possible, the patient must be regularly observed by a doctor and strictly follow all his instructions.

Vertebral artery syndrome and cervical osteochondrosis are interrelated diseases. Against the background of a pathology that affects cervicothoracic region spine, adults may experience associated symptoms, for example, a feeling of heaviness, pressure in the temples, dizziness, spots in the eyes. This condition is caused by decreased blood flow in the vertebral artery.

The syndrome can occur as a result of irritation, compression by the edges of vertebrae damaged by osteochondrosis:

the left vertebral artery, pinching of which is accompanied by noise, pain in the ears, pain in the eyes, a burning sensation in the area of hair growth on the back of the head, mainly on the left;
right vertebral artery, damage to which shows similar signs, except that pain and discomfort mainly on the right side.

A disease that, according to ICD 10 code, is called irritation syndrome of the sympathetic plexus of the vertebral artery , dangerous because it can lead to early development cerebral ischemia and a number of other diseases, for example.

Symptoms of pinched vertebral arteries

The most common sign of blood vessel damage is headache. Attacks happen suddenly painful sensations are localized in the occipital region and can “spread” to the forehead and temples. Over time, this symptom intensifies, the headache recurs more and more often and occurs when turning, tilting the head and even a sudden change in position.

Even the skin and hair can hurt, especially when touched or combed. There is a burning sensation in the back of the head. A person can hear the crunching of the vertebrae when he turns his head.

The following symptoms are less common:

hypertension;
noise, ringing, pain in the ears;
dizziness, feeling of lightheadedness, even loss of consciousness;
attacks of nausea;
pain in the eyes, blurred vision.

The occurrence of arrhythmia against the background of vertebral artery syndrome is also not uncommon, because there are nerve connections between the heart and the cervical spine, which in case of cervical osteochondrosis provoke the development of cardiac disorders.

The vertebral or vertebral arteries pass on both sides of the cervical spine, but upon reaching the brain region, they merge into the common basilar artery, which supplies several brain regions:

cerebellum;
brainstem and cranial nerves;
temporal lobes;
inner ear.

Although the vertebral arteries supply the brain with 15 to 30% of the blood, their pinching and damage lead to oxygen starvation. Paravertebral artery syndrome with cervical osteochondrosis makes itself felt by impaired coordination, frequent mood swings, and headaches. It is quite difficult to diagnose it until a person has a pathology that destroys bone structures cervical spine.

How the disease develops

Causes of vertebral artery syndrome in cervical osteochondrosis:

Most of the blood vessel supplying the brain passes through the mobile canal, which is formed by the vertebrae and their processes.
The right and left vertebral arteries are intertwined with Frank's sympathetic nerve.
When the distance between the vertebrae decreases, because bone formations with thinned discs sag, pinching blood vessels and nerves.

The lumen of the artery narrows, and enters the brain less blood, accordingly, the functioning of the sections that feed these particular blood vessels is disrupted.

What does the syndrome entail?

If the condition is not treated, the disease will progress to the organic stage, which is characterized by transient ischemic attacks. Attacks are expressed by sudden, impaired coordination, speech, and are accompanied by nausea and vomiting.

An attack can be provoked by a sudden movement of the head, turning, bending, or a change in position, sitting or lying to standing. However, if a person lies down during the condition, the intensity of the symptom will decrease, nausea and dizziness will pass.

After such attacks, the following may persist:

weakness;
feeling overwhelmed;
flashes before the eyes.

Advanced vertebral artery syndrome leads to drop attacks, or sudden falls of a person who remains conscious, but cannot move or stand up on his own until he recovers motor function. This happens because the tail parts of the brain and the cerebellum do not receive enough nutrition.

The most dangerous consequence of an untreated condition is a stroke. The symptom is diagnosed by a doctor, for this you may need:

X-ray examination of the cervical spine;
magnetic resonance or CT scan neck;
artery scan.

If the diagnosis is confirmed, the doctor will prescribe treatment.

How is the treatment carried out?

If the symptom was provoked by a pathology that destroys the vertebrae, the doctor will prescribe a comprehensive treatment for vertebral artery syndrome with cervical osteochondrosis, which includes:

therapy for the pathology that led to the development of the symptom;
restoration of arterial lumen;
additional treatment and further prevention.

To relieve pain, a person will be prescribed medications anti-inflammatory, for example Meloxicam.

Other medicines:

decongestants, Celecoxib;
angioprotectors, venotonics, for example, Diosmin, Troxerutin;
drugs that relax spasmodic muscles, for example, No-shpa;
chondroprotectors, which are aimed at restoring the cartilaginous structures of the spinal column;
general strengthening complexes of vitamins and minerals.

If the artery is severely compressed by damaged vertebrae, physiotherapy is prescribed. If the method does not help, surgery is recommended.

The standard treatment for vertebral artery syndrome, which has developed due to osteochondrosis, involves physiotherapeutic procedures, which are carried out in a hospital setting.

The treatment regimen includes not only medication, physical therapy, but also therapeutic exercises, which must be done every day. The exercises can be done at home.

Health-improving physical education

Therapeutic exercises for vertebral artery syndrome are aimed at relaxing spastic muscles, restoring blood circulation, and supporting the spinal column. The muscle corset of the cervical region is weak, therefore, when strengthening it, it is important not to overdo it:

under no circumstances make sudden movements, turns, or tilts of the head;
Perform all movements of the gymnastic complex slowly and smoothly, without overloading the neck muscles;
refrain from performing therapeutic exercises during periods of exacerbation of osteochondrosis, intense attacks of headaches, dizziness;
during physical education, provide an influx of fresh air, for example, open a window, go out onto the balcony.

Bubnovsky’s exercises for vertebral artery syndrome and cervical osteochondrosis are good because they can be performed at any time of the day, sitting, lying or standing. Some movements can be done even in public transport and during a work break:

Metronome, an exercise during which you need to tilt your head alternately different sides and hold the position for half a minute.
The spring includes smooth movements of the head down and back. In this case, you need to tilt your head as low as possible, but slowly and smoothly.
The frame uses not only the neck and head, but also the arms. Right hand need to put on left shoulder, and turn your head in the opposite direction, that is, to the left. Hold the position for half a minute.
The fakir turns his head in different directions with his hands clasped at the top.
The heron is performed with the back as straight as possible. The person puts his hands on his knees, then smoothly moves them behind his back, lifting his chin up.

The exercise is completed while standing, with the person turning his head, trying to touch his chin to his shoulder with each movement.

More details from therapeutic exercises can be found on the video.

Disease prevention

Basic measures to prevent the development of a symptom that can lead to a brain stroke include living a healthy, active lifestyle and quality rest. Therefore, a person must take care of bedding, a comfortable orthopedic mattress and pillow.

Prevention of vertebral artery syndrome in cervical osteochondrosis includes correction of nutrition and lifestyle. A person should:

visit more fresh air, take walks;
eat a varied and nutritious diet, do not overeat;
if the work is sedentary, for example, at the computer, in the office, do a neck warm-up every hour and a half;
stop smoking;
do not abuse alcohol.

These simple rules will help maintain the health of the back and vertebral arteries, so that a person will feel active and cheerful, and attacks of dizziness, nausea, and tinnitus will become a thing of the past.

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A disorder such as vertebral artery syndrome in cervical osteochondrosis can significantly impair cerebral circulation. A person experiences frequent headaches, difficulty breathing, thought processes slow down. Despite the fact that the spinal blood vessels supply only a small percentage of blood to the occipital part of the brain, disturbances in their functioning can cause enormous harm to a person.

With osteochondrosis, compression occurs not only on nerve endings, but also on blood vessels. In the cervical spine, such processes are especially dangerous and require immediate treatment.

To understand the essence of the problem, let’s remember what the vertebral artery is. There are actually two of them: each starts from a different artery in the shoulder area and extends to the back of the brain.

The first sign of compression of such a blood vessel is dizziness. Insufficient oxygen reaches the brain, and the person quickly begins to feel imbalanced.

With cervical osteochondrosis, the structure of the spine is disrupted, protrusion intervertebral discs, muscle spasms occur. This whole complex of problems creates increased pressure on the vertebral artery, and blood circulation is impaired. The condition is aggravated by compression of the nerve endings. Pain syndrome aggravates muscle spasms, thereby pinching the artery even more.

Causes

Vertebral artery syndrome can occur for a number of reasons. They can be divided into 2 large groups: congenital and acquired.

Congenital

This may include developmental pathologies of the vertebral arteries themselves. From birth, the artery may be of the wrong diameter or have extra bends. Such pathological changes in the structure of arteries are dangerous for humans.

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Purchased

You can write in this category various injuries spine, tumor formations, pathological processes V spinal column. The most common problem is osteochondrosis of the cervical spine and all its complications: protrusions, hernias. In such a situation, there is a slow compression of the vertebral artery, which a person usually notices with the onset of dizziness. Often the blood vessels are not compressed themselves intervertebral discs, and bone growths - osteophytes.

It is important to seek help at the first symptoms medical care so that oxygen starvation does not occur.

At mechanical damage of the spine in the cervical region, compression of the artery may occur, which will not subside due to a violation of the structure of the spine and muscle spasm. In case of injury, you should immediately consult a doctor.

Short-term manifestations in the form of dizziness can be the cause of poor head position during sleep. Symptoms usually start after waking up and go away as quickly as they appear. To speed up the normalization of the condition, you can do a light self-massage of the cervical-collar area. This will reduce pressure on the arteries.

Physiotherapy

With vertebral artery syndrome and cervical osteochondrosis, treatment should be managed exclusively by a highly qualified doctor. And this applies not only to medications. It is important to choose the right methods of massage, gymnastics, and various medicinal procedures.

The cervical region is a very sensitive area in the human body. Here, like in no other part of the spine, you cannot self-medicate, even with the help of massage and exercises. All procedures are prescribed by a specialized doctor.

Procedures

After full diagnostics, in addition to drug treatment, the doctor prescribes physiotherapeutic procedures:

Electrophoresis using analgesics;
Impact magnetic fields;
, restoring blood circulation;
Weak current stimulation;
Point impact with needles;
Diadynamic therapy.

Massage

It is important to find a professional massage therapist for this purpose. Good massage incredibly effective and is an excellent addition to the main treatment. IN in serious condition If you are ill, it is better not to engage in self-massage, even light massage. But if the disease is in the very early stages of progression, you can consult a doctor about self-massage; this will be a relaxing procedure after waking up.