CURRENT METHODS OF PHYSICAL REHABILITATION USING ADAPTIVE PHYSICAL CULTURE FOR INDIVIDUALS WITH LUMBAR SPINE SPONDYLOLISTHESIS AT THE OUTPATIENT STAGE

Abstract

Background and objective. Spondylolisthesis is a pathological condition characterized by the displacement of a superior vertebra relative to an inferior one in the horizontal plane, with a prevalence in the general population ranging from 2 to 7%. Lumbar localization predominates in the vast majority of clinical cases, primarily at the L4–L5 and L5–S1 levels, due to the maximum biomechanical load on the lower lumbar segments of the spinal column. The pathogenetic basis of the disease is instability of the vertebral motion segment, leading to chronic pain syndrome and significant functional limitations. The aim of this study was to systematize current methods of physical rehabilitation using adaptive physical culture for patients with lumbar spondylolisthesis at the outpatient stage.

Materials and methods. An analysis of domestic and foreign scientific publications on conservative treatment of spondylolisthesis was conducted. The classifications of the disease (Meyerding, Wiltse), principles of therapeutic exercise prescription, methods of deep muscle stabilization training, as well as specialized rehabilitation techniques including post-isometric relaxation, proprioceptive neuromuscular facilitation, Pilates system, and hydrotherapy were reviewed.

Results. It was established that conservative treatment using adaptive physical culture is the first-line method for Grade I–II spondylolisthesis. The highest level of evidence supports segmental stabilization exercises with training of deep stabilizer muscles — the transversus abdominis and lumbar multifidus. Randomized controlled trials confirm a statistically significant advantage of specific stabilization programs over standard conservative treatment in terms of pain intensity and functional status, with effect maintenance in the long term.

Conclusions. Optimal functional outcomes are achieved through a multimodal approach combining stabilization exercises, manual techniques, hydrotherapy, adaptive motor recreation tools, and patient education. The outpatient stage requires adherence to the principles of staging, individualization of physical load dosing, and systematic effectiveness monitoring using validated scales. Critical importance lies in developing proper motor patterns and ergonomic behavior skills in daily life to prevent disease progression.