Prevention and therapy of health complications caused by bullet-resistant protective vests.

Figure 1: Group wearing bulletresistant vests somewhere in the Middle East

Personal protection by body armor lost its significance with the appearance of firearms. However, “body armor” reappeared around the middle of last century as a consequence of technical development. Today bullet-resistant vests offer protection against the lead core bullets of pistols and submachine guns on the entire surface of the protective gear, as well as against the steel core or armor-piercing projectiles of carbines, assault rifles, rifles and machine guns on the surfaces with additional protective inserts, and against the regular or irregular shrapnel of hand grenades at an appropriate distance. Personal equipment – whose total weight can reach 40 kg – may influence the soldier’s combat activity in battle. The weight of equipment makes the exploitation of expensive technical equipment critical, since its user loses the ability to move quickly and mobility. 

The Hungarian Home Defense Forces have equipped their troops – mostly those in missions – with bullet-resistant vests since 1995. The protective combat vest version of the 95M bullet-resistant vest product line is a special, upper-garment-type personal protective gear for the protection of the upper body, the neck, the shoulders and the groin. This vest prevents projectiles and shrapnel of a certain energy and structure from penetrating its protective material, thus it shields the protected body part/surface from injury exceeding a determined extent. The 95M protective vest is manufactured in Hungary, made of aramid. One of its special characteristics is that the size of the protected body surface in proportion to its specific weight was outstanding among the protective vests used worldwide even at the time of its creation. The average weight of protective vests (depending on sizing and the material of the cover) is 5.5-7.5 kg, whereas the weight of the version made of high-strength polyethylene was reduced to 4.2-5.1 kg in the course of later developments. The weight of additional protective inserts was reduced from the initial weight of 3.8 kg to 3.02 in the course of time and as a result of technical development. In the areas of operations of missions two additional protective inserts (with a protective surface of 320x250 mm, for the protection of the abdomen and chest, as well as of the middle back) are standard for one bullet-resistant vest. The basic load of a person – of average size – wearing up-to-date protective gear corresponding to the technical standards of the age increased by approximately 10-14 kg. Due to the development in materials and technology this has been reduced to 8-11 kg at present, which is still significant. In areas of operations, loads affecting the upper body may be worn continuously up to a period of 24 hours. 

Figure 2: Soldier in protective clothing

The number of troops shows a decreasing tendency in all armies of the world, but in all cases accompanied by an increase in military efficiency. In the personnel of the armed forces appropriate mental and physical ability are fundamental requirements. Physical capacity has certain biological prerequisites as well, which, however, partly depend on age, level of development, and biological gender.

Armed forces cannot avoid taking into account the following in the course of the continuous and complex development of the personal equipment of combat personnel:

• firepower and the elaboration of the new requirement system of C4I,
• reducing the equipment worn by soldiers on the battlefield,
• interoperability,
• the prevention of injuries in order to maintain the ability to fight, 

As one fighting soldier is “worth” about USD 50,000, loss of troops (and/or equipment) is not permissible.

Table 1. Physical load (based on 1992 data)

Weight of equipment  [kg]	Initial conditions	According to the army modernization plan
Clothing and personal equipment	11.38	6.30
Weapons and ammunition	14.00	8.50
Radio and optics	6.35	2.50
Food and water	5.90	4.30
Ballistic protection	4.00	2.80
NBC protection	3.80	2.60
Total	45.43	27.00

In the case of an order for attack, the load of a soldier (exclusive of the backpack) cannot be greater than

In the USA: 25 kg,                    In the UK: 27 kg

The weight of the equipment of troops serving in deployments in Asia is over 30 kilograms, which often has to be worn for 14 hours per day. This represents a strain even in winter, let alone in summer. Significant losses of water and magnesium developing in great heat, in the case of intense strain or exhausting physical activity lead to the appearance of muscle cramps. In the case of increased perspiration the daily need for magnesium is obviously higher, since significant amounts can be lost due to the higher magnesium concentration of perspiration compared to that of the blood, but elimination through urine and stool also plays a role. The magnesium levels of the blood do not reflect total magnesium levels, since only a modest proportion of total magnesium is present in the blood. Magnesium deficiency can lead to disorders in nerve and muscle function, especially the over-stimulation of the membrane of muscle fibers.

In Hungary, police officers are exposed to the following weight loads:

• Summer service apparel, with equipment: 6.6 kg.
• Winter service apparel, with equipment: 9.7 kg.
• Summer riot control clothing, with equipment: 22.3 kg.
• Winter riot control clothing, with equipment: 24.2 kg.
• Special summer deployment clothing, with equipment: 17.9 kg.
• Special winter deployment clothing, with equipment: 19.9 kg.

Cold weather, catching colds and sudden falls in temperature can also cause muscle pain, and individual sensitivity to climatic factors plays a fundamental role here. A fall in body temperature following strong perspiration during service, or a sudden wind can cause low back complaints. In areas of greater humidity, at sea or on the coast, there are more complaints of myalgia than in the case of those living inland. It cannot be expected of soldiers serving in heats of 40-50 grades Celsius to cope with distractions caused by their body (cramps, pain, impaired movement) while wearing equipment or executing tasks.

The structure and functioning of the backbone

The backbone can be regarded as a unitary organ, whose condition has a key role in preserving health. Areas corresponding to all of our organs can be found on and along the backbone, as well as on the soles of our feet or on our palms. When a deformation occurs in this region, it can sooner or later damage the internal organs as well. If any impact occurs in any of the regions of the backbone, it will manifest in the other regions as well. The spinal cord is the center of the body, which contains inferior nerve centers; it is approximately 45 cm long and 1.25 cm in diameter, extending from the skull to the first lumbar vertebra. The spinal cord entirely consists of nerve tissue, with white matter surrounding the gray matter in the middle. Thirty-one pairs of spinal nerves extend from the backbone at regular intervals. The structure of the backbone consists of 24 true and 9-11 false vertebrae. The majority of motor organ problems are related to the central nervous system, that is, the brain and the spinal cord, which form the comprehensive coordinating system of the body. Motor organs make up two-thirds of the body mass of the human body, and because of this they play a fundamental role in the operation of the entire body at every time. The skeletal system is especially important as regards physical capacity and capability. Muscle movements play a part in all vital processes.

The basic function of the backbone is to ensure the stability and balance of the body. At its lower end it is connected with the pelvic girdle through the sacrum, and in the thoracic section it forms the chest together with the ribs and the sternum. Spinal curves distribute the pressure resulting from the upright position – developed in the course of evolution –, and this sinusoid-like curvature, a human characteristic, is a masterpiece of engineering, which is extremely solid and flexible at the same time [1][2]. The fundamental function of this part of the skeleton, showing a double S-shape curvature in the sagittal plane, is to bear optimally the weight of the body, and to transfer compression and bending forces to the pelvis and the lower limbs in an appropriate way, in order to ensure the adequateness of the basic functions of the human body during standing, walking and work. This curvature absorbs shaking and impact during walking, without which the skull would be exposed to such shock that we would suffer concussion with every step. The backbone shows mild curvature in the frontal plane as well, it curves slightly to the right in the thoracic section and slightly to the left in the cervical and lumbar section. In the backbone of women, lumbar lordosis is usually more accented, often compensated for by kyphosis in the thoracic section. The backbone bears the weight of the trunk, that is, most of the load, therefore the injury to the upper and lower vertebrae resulting from overload also manifest in the backbone. The lumbar section of our spine is one of the most used regions of our body [3][4][5]. 

The vertebral motor segment has a fundamental role in ensuring stability. It was Junghans who created the concept of the “motor segment” of the backbone, which consists of the body of the vertebra, the intervertebral disc, the anterior and posterior longitudinal ligaments, the related joint surfaces and the ligamentum flavum, as well as the facing surfaces of the bodies of vertebrae in the related section of the vertebral canal. Ligaments and muscles are also organic parts of the segment (see Figure 3.). The vertebral motor segment can be regarded as stable if under physiological loading conditions it preserves its physiological movement range without the impairment of neurological function in the vertebral canal inside it and in the region of the intervertebral foramen. Instability can occur along all axes of movement of the backbone in the case of inappropriate loading. The task of the system of ligaments is to hold joints in the position determined by the muscles. The anterior vertebral ligaments, direct, coordinate and regulate movement. The ligament running along the posterior surface of the bodies of vertebrae is situated in the vertebral canal. Four types of basic movement can occur in the backbone (flexion, extension, lateral flexion, and rotation). Combinations of these occur in practice in all cases. 

The most important connections between the vertebrae are represented by the intervertebral discs. In normal condition, the disc can be understood as a sac filled with hydrogel, and this intervertebral zone functions as a puffer zone. The hydraulic biomechanical function of the disc ensures that the nucleus pulposus counteracts axial compressions with a passive extension force. Due to the geometry of its fibrous structure, the annulus fibrosus neutralizes shear stress as well as (axial and paraaxial) rotation forces. If pressure is exerted on the disc, it will spread equally in all directions (Pascal’s law). The nucleus pulposus makes up 40-60% of the mass of the disc. It adapts to movement and loading, while it is protected by the outer ring. Discs do not have their own circulation, nutrients are supplied by the flow of articular fluid. The height of the intervertebral disc can decrease by up to 1-2 mm, when the disc flattens out, and its diameter can increase by 1 mm. The disc has a role in ensuring that the backbone is able to turn, twist and bend. The tissue structure of the disc ensures the suppleness and flexibility of the backbone, as the fluid content of the jelly-like nucleus pulposus is ca. 90%, thus it resists compression. When the fluid content of intervertebral discs decreases (or disappears), the nuclei pulposi become inflexible and the fibres of the annulus fibrosus fibrillate, as a result of which it cannot fulfil its basic function. The annulus fibrosus, which consists of collagen fibres arranged in lamellae, surrounds the nucleus pulposus in a spring-like fashion. Pressure exerted here will be transferred entirely, without reduction to the end-plates under the damaged disc, which results in significant pain, and increased loading of the muscles due to the reduction in function. The resulting muscular imbalance leads to overloading, pain and function impairment, or in more severe cases to the antalgic posture. Body height changes every day due to fluid loss in the intervertebral discs. In upright posture height decreases to the end of the day (due to posture and the tiring of the foot arch), the variation can be as much as 5 cm. Our height is restored overnight. The fluid loss of discs can increase due to great physical loading and 

Figure 3: The biomechanics of the backbone 1. Anterior longitudinal ligament; 2. Posterior longitudinal ligament; 3. Nucleus pulposus (behaves as a spring); 4. Annulus fi brosus; 5. Small intervertebral joints function as swivels; 6. Muscles perform and regulate movement

increased pressure.

Every weight which represents a persistent load on the body will affect the joints and the backbone after a while. The backbone is exposed to several forces: physical and psychical loads, body mass, the tension of muscles and ligaments, abdominal pressure, as well as external forces, such as clothing, equipment and protective gears. In the course of loading the bony origins and insertions of the muscles may become damaged, these are so-called periostitis symptoms, when circumscribed pain may occur in the pelvic bones and in the vertebral arches and processes. The tonus and binding of muscles can decrease or intensify vertebral pain. All muscles are determined for only one type of movement, contraction. Long-term physical loading of the muscles cause muscle pain, which is characterized by a protracted rigid and cramped muscle condition and can be accompanied by loss of function. Long-term stress can also result in persistent tension and increased contraction in the paravertebral muscles. The exhaustion of the muscles can lead to persistent low back pain. The condition of the muscles may be aggravated by the contraction of the capillaries of the muscles. Local ischemia can occur in the blood vessels. As a result of increased muscle work, tissue hypoxia can develop, the concentration of glycosaminoglycans becomes higher in working muscles, which leads to the appearance of swelling, muscle pain and muscle soreness. Glycosaminoglycans (hyaluronic acid, chondroitin, chondroitin sulfate, keratin sulfate, etc.) make up 0.5-5% of connective tissue. Due to their high molecular weight and strong ability to bind Ca++, they bind a significant amount of water. Water makes up about 20% of the mass of bones. Pain and contraction occurs in the muscles, which exerts pressure on the nerve endings as well, moreover, hemorrhages can occur in muscle elements. When posture is hunched or bends to the side, this subtle balance is upset. A common symptom is the significant spasm of deep back muscles, especially if the body of the vertebra or the transverse processes are fractured. The fracture of the spinous processes generally occurs at a young age, as a result of excessive muscle strength. The bony processes of the body of the vertebra ensure stability and only participate in the movement of the backbone in a passive manner. Pain originating in the vertebrae can occur in the body of the vertebra or the region of the anterior ligament, which pain is of lower intensity, since this region is not rich in sensory nerves. When pain is related to the region of the arches and intervertebral foramina on the posterior part of the body of the vertebra, joints cause intense, torturing pain. The increased thickening of the ligamentum flavum can have a narrowing effect and cause symptoms of radiculitis [6][7][8][9]. 

The backbone is vulnerable and sensitive to strain, therefore we must pay attention to our posture, in order to decrease the strain on our backbone. Since our bodies are supported by two legs instead of four, the center of gravity of the body has changed. The center of gravity of the body is the point where it has to be supported to remain at rest in a homogeneous gravitational field. The maintenance of our backbone is part of the preservation of our general strength and condition. Posture refers to the posture of the entire body, including that of the torso and the limbs. In practice posture means the position of the backbone, which is influenced by internal and external spatial forces. In the case of correct posture the forces of the body and the force of gravity affecting the body are in a state of equilibrium. In this case the tension of articular capsules and ligaments correspond to physiological conditions, the muscles responsible for posture cooperate harmoniously, symmetrically, the strength exerted and energy consumed by the muscles are minimal, and as a result, the loading of the intervertebral discs and articular surfaces is evenly distributed. The more the line of gravity of the body deviates from the physiological line of gravity, the greater the load on the small joints and the intervertebral discs. This sensitive equilibrium especially characterizes the lumbar section, since this is where the greatest forces are exerted in order to keep the body in an upright position, and this is where the mobile backbone is connected to the fixed pelvis. Long-term disharmony can lead to the exhaustion of the muscles and ligaments, thereby the section of the backbone will fall forward or backward. The muscles supporting the vertebral column will cramp with every strain, and transfer the task to the rest of the muscles [10]. Every type of increase in weight changes the state of balance of the body. Exhausting exercise and physical loading – especially if they involve twisting movements – are common causes of backbone pain. (When stepping forward, a turning movement occurs between the seventh and the eighth thoracic vertebrae. This is the region from where the upper part of the body turns in one direction, while the lower part turns in the opposite direction.) [11][12][13]

Muscles perform active movement and the active stabilization of the torso in all positions. The basis of perfect movement, just as in the case of the limbs, is the harmonious cooperation of opposite muscle groups (e.g. abdominal muscles and back muscles). Muscles work in pairs (agonists and antagonists). When a muscle contracts, its opposite (proprioceptive function) relaxes. A change in the operation of any muscle group – whether caused by weakening, shortening or a cramped condition – leads to the upsetting of muscle balance, resulting in various motor organ complaints. If we consider the hard work our muscles have to perform to sustain our body in various positions or to move it, working against the force of gravity, it becomes understandable that various posture disorders or persistent unidirectional strain cause muscle cramps and muscle pain.

When the spinal curvatures are physiological, load is borne by the bodies of the vertebrae, but if external forces dominate, the state of balance of the body is upset, and the muscles, ligaments and bone sections in the direction of the force’s impact will be exposed to increased strain. In the case of correct posture, muscles only use enough strength to keep the correct posture. In upright position the backbone has a supporting and stabilizing function. In this case the weight of the body is transferred to the pectoral girdle, and through the system of the chest and the abdominal cavity to the pelvis. Incorrect posture, especially an enhancement of the lumbar curvature (which is always accompanied by insufficient functioning of the abdominal muscles) deteriorates the operation of the system. The overstraining of various sections of the backbone is a consequence of this. Incorrect posture increases the strain on the intervertebral discs and ligaments in all cases. Minor or more serious deviations of the backbone also play a part in the development of pain. The stabilizing effect of the muscles is different during movement (e.g. in the case of a sudden movement or lifting a heavy weight) than in upright position. The deformation of any of the components of the backbone can cause backbone pain. In the case of the degeneration of intervertebral discs, the height of the discs decreases, reducing the distance between the vertebrae, which affects the functioning of the small intervertebral joints situated in the back in all cases. The posterior ligament running along the backbone may become stretched, or it may be pressured by the bulging of the disc, causing pain. Pain can also occur in the nerves due to the prolapse of the intervertebral disc, that is, disk herniation, or to pressure caused by other soft structures [14][15][16]. 

As regards posture, we can distinguish static posture, which is the position from which movement originates and in which it ends. Therefore, if this posture is incorrect, muscles will work inappropriately during the entire process of movement, which will greatly affect movement and balance. Obviously, as a result, dynamic posture will also be affected. Dynamic posture may be defined as the ability to always maintain an optimal rotation axis during movement combinations in any plane of movement.

Bullet-resistant protective vests or other gear representing a load on the body can cause other problems besides affecting the backbone. Since it is usually the shoulders or the pelvis which serve as the most suitable place for fixing or supporting gears, these regions are also subjected to outstanding strain. Thus it is also very important to observe the free movements and general condition of the shoulders and pectoral girdle, as well as of the pelvis and pelvic girdle. The regions of the neck and shoulders are prone to muscle spasms, when these regions become bound and painful. This is caused by incorrect posture and an incorrect use of muscles, and the pain usually radiates in the direction of the neck, head and the shoulders. 

To prevent physical strain from causing permanent deformations in the body, besides the strength training of soldiers and police officers we recommend the inclusion of exercises which serve the development of correct posture in the training program. 

In the training stage the gradual loading of the skeletal system is ensured by a professionally qualified training team. The basis of achieving good results is a backbone and joints which can function in the entire movement range in all directions, as well as a musculature which can ensure correct posture. In practice, this involves two – seemingly contradictory – tasks: ensuring stability and dynamism during movement.

Stability can be achieved by training those muscles which play a part in maintaining correct posture. Their practical role can be detected in that they protect the individual from pain caused by posture disorders and simple states of tiredness, and even from conditions developing due to inappropriate functioning. The other requirement, dynamism, enables the muscles, increased in strength and performing active and varied work, to work efficiently in the entire movement range of the backbone. 

Problems resulting from backbone strain can be reduced or eliminated by improving posture, kinesiotherapy, electrotherapy and chondroprotective products.

Today up-to-date medications are available for treatment, but in spite of this, there are still a lot of motor organ patients worldwide for whom no appropriate, effective therapy exists. When acute problems are not treated appropriately, they become chronic. Various methods of physical therapy and physiotherapy are available in order to achieve successful treatment. Of conservative treatments, strengthening muscles by regular swimming and physiotherapy are very important. Stretching contracted muscles, the use of exercises facilitating correct posture in the patient and breathing exercises also help improve the general condition of the body. Relaxing stretching exercises are eminently suitable for relieving the cramped tension of muscles and enhancing microcirculation. However, physiotherapy on its own is not sufficient. 

Kinesiotherapy

Posture correction and muscle strengthening:

Figure 4: Impaired microcirculation /left/, healthy microcirculation /right/.

The optimal angle of the pelvis and the sacrum – the lumbosacral angle – and the physiological curvatures of the backbone are very important for correct posture. The appropriate position of the pelvis is the key to correct posture. The weight of the body is evenly distributed to the arched structure of the lower limbs and the feet through the arched structure of the pelvic girdle and the hip joints. The work of the muscles moving the backbone may be compared to the ropes supporting the mast of a ship, where the hull of the ship represents the pelvis, whose physiological angle is 60 degrees. This determines the position of the hip joint on the one hand, and the physiological extent of the sagittal curvatures of the backbone above it on the other hand. 

It is advisable to begin posture correction by adjusting the position of the pelvis and by relaxing the muscles responsible for the movement of the lumbar section of the backbone and the pelvis. Muscles whose length deviates from physiological conditions cannot work with full strength. Appropriate kinesiotherapy can only be planned after identifying rigid or weak muscles. After the mobilization and stretching of the muscles which require stretching we can go on to the muscles which have to be strengthened, and then continue with improving the coordination of the musculature whose balance has been restored. Success can be achieved by a purposefully planned therapy. Kinesiotherapy is preceded by a thorough examination of movement, which reveals which muscles have to be strengthened or stretched.

Execution of the following string of exercises has to be observed and coordinated by a specialist in all cases, since the efficiency of the exercises depends on the precise adjustment of initial and final positions. The active protagonists of these movements are the paravertebral muscles, the abdominal muscles, the iliopsoas, as well as the gluteal and thigh muscles. When abdominal muscles work properly (they keep the contents of the abdominal cavity close to the backbone), they also support part of the weight of the body. As a result, the backbone and the pelvis are partially relieved from pressure.

Warm-up exercises:

1.Begin warm-up by twice inhaling and exhaling deeply; you can complement this by the conscious direction of breathing, which can be achieved by placing a hand on the abdomen or the chest, or on the curve of the collarbone.

2.Raise both shoulders, then let them down, and rotate your shoulders backward, then forward.

3.Push the top of your head upwards as if you were balancing a book, and, holding it in this position, slowly bend your head to one side, to the center, to the other side, take a few deep breaths, and finally turn your head to the right, center, left, then up and down.

4.Swing your arms forward in smaller, then greater and greater circles.

5.Bend and cross your arms in front of your chest. Swing your arms to the side to the height of your shoulder, then back to a crossing position in front.

6.Complement the previous exercises by slightly bouncing on your knees – bend your knees when your arms are crossed, stretch your knees when your arms are stretched, bend and stretch.

7.Rotate your hips as if you were using a hula hoop.

8.Bend forward, slide your hands down your legs to your knees, or further down, if possible. Straighten up and bend slightly backward.

9.Walking on the spot, raise your knees higher and higher, as if you were marching. Following this, lightly walk on the spot for one minute.

10.  Finish warm-up by twice inhaling and exhaling deeply, allow your lungs to become completely empty.

The bending and strengthening exercises increase the amount of energy stored in the muscles, thereby decreasing the possibility of injury caused by sudden movements. The exercises improve the range of movement of joints and cartilages, and increase the tensile strength of tendons and the production of articular fluid. The exercises free the joints, thus the muscles and tendons return to their original state of balance.

Kneeling exercises

1. Stand on your hands and knees, your hips and shoulder should remain perpendicular.
2. Approach your head towards your knees, keep your palms and knees on the ground, curve your back, then roll back.
3. Curl your back upwards, like a cat.
4. Lower your back with your bottom and head pointing upwards, and your trunk in a concave curve.
5. Hold your back straight, and extend your opposite arm and leg horizontally. Repeat with your other arm and leg. Pay attention to keeping your balance!

6. Turn your fingers so that they face each other below the line of your chest, and bend your arms with your palms farther apart than your shoulder width.

7. Continuing the previous exercise, keep your arms bent – with your chest 20-30cm from the ground – and stretch first one and then the other arm on the ground.

8. Put your elbows on the ground while kneeling, so that your thighs and upper arms are at right angles with the ground, your lower arms should be parallel, and curve your back upward and then downward in this position for a few times. 

9.Kneel and sit on your heels. Balancing with your arms, swing your bottom to the right so that your right hip touches the ground and your arms swing to the left. Then raise your bottom and sit on the other side, keeping your arms on the left. Repeat the exercise six times, three times in both directions.

10.  Stand up and stretch towards a horizontal bar or door lintel. Grab it and hang from it so that it supports all of your weight. If it is necessary, bend your knees to be able to hang, and feel your backbone stretch. Hold this position and count for 15-30 seconds, with eyes closed, then relax. Let go of the bar, and stand in initial position.

Core strengthening

Bending the backbone backward:

1. Lie on your stomach, place a pillow under your abdomen, your arms resting next to your body with palms downwards. Raise your head from the ground, hold it high for a moment, then lower it, while keeping your eyes closed.
2. Lowering your shoulders, raise first one, then the other leg, both legs 5x, to about 15 cm from the ground, squeeze your buttocks, then put down your legs and relax.
3. As you become stronger, try raising your head, shoulders and legs from the ground at the same time – but always for a few centimeters only.

Bending the backbone forward:

1. Lying on your back, pull up your legs so that the soles of your feet are resting on the ground – bend your knees –, and curl forward, sliding your palms up your thighs to reach your knees – hold up your head. 
2. Repeat the exercise by approaching one elbow to the opposite knee. Alternate elbows.
3. As you become stronger, raise the opposite knee – pull up your legs to your abdomen – to reach your elbow. Work alternately on both sides of your body.

Leg raises:

1. Lie on your stomach on a table or a lying bench, with your hip at the edge of the table. Grab the table to support yourself.
2. Raise both legs so that they are level with the table. Take care not to curve your back. Remain in this position while counting to three, then slowly, carefully lower your legs.

3.Then lie on your side, supporting your head with the arm in lower position, and support yourself with the other arm in front of your chest. Bend your lower leg, and raise your stretched upper leg. Bend your feet at a right angle at the ankle, rather then forcing your toes down.

4.Put your upper leg forward on the ground. Raise your lower leg a little.

5.Turn around and repeat the exercises lying on your other side.

Sit-ups – deep abdominal muscle training:

1. Sit on the floor, and pull up your knees so that they are at right angles with your chest. Stretch your arms forward for balance.
2. Roll backward as far as it is comfortable for you (the chest draws away from the knees, the back approaches the ground, curled, but does not touch it), maintain the movement with your abdominal muscles, and count to five while holding the final position.
3. Pull yourself up straight with the help of your abdominal muscles.

Stretching:

Back stretching:

1. Lie on your stomach, support yourself with the palms under the shoulders, legs slightly apart, pelvic girdle relaxed, and pull your chest upward to stretching limit, holding your head. Repeat 3 or 5 times. 
2. Lie on your side and curl as much as you can. Feel your backbone stretch.
3. Slowly, gently straighten your backbone, stretch your arms above your head, straighten your legs and hold your feet down, pull in your stomach, squeeze your buttocks and stretch. 

Pelvic curls:

1. Sit on a chair, and curl your midsection in a concave curve, pulling away from the back of the chair. 
2. Now curl your back in the opposite directions, so that it presses against the back of the chair. Repeat five times, then finish with the lumbar section of the backbone staying between the two end positions. Place your hand on your hips, and curve your back concavely by curling your pelvis forward, as if you were pushing your bottom backward.

3. Then retract your pelvis, and pull your bottom under you. When finishing the exercise, your back should be halfway between the two end positions.

Knee stretches to the side:

1. Lying on your back, pull your knees up to your chest, circle them with your arms, then put down the soles of your feet and stretch your arms to the side.
2. Roll your knees from one side to the other.

Magnetotherapy

Treatments based on conventional magnetic field therapy use static (permanent magnets) or pulsating fields, employing sinusoidal, rectangular, trapezoidal and sawtooth signals. Magnetic fields can be defined by three parameters, the form of the pulse (signal shape, which can be indicated as a wave), frequency (measured in Hertz) and flux density (the strength of the field expressed in Tesla). With these three parameters, an infinite number of different magnetic fields can be created. 

The BEMER therapy is a special electromagnetic field therapy protected by an international patent, which is the result of more than a decade of research. The therapy uniquely improves microcirculation (dcapillary < 200 µm). The extent of improvement is 24% after an application of two minutes (see Figure 4). Besides broad-spectrum impulses, the BEMER 3000 Plus devices also have a Plus modulation which influences vasomotion (the flexible movement of the walls of blood vessels). These new-generation devices improve vasomotion by approximately 19% after an application of two minutes.

Research and development is lead by Dr. med. Reiner Klopp, director of Berlin Microcirculation Institute. The studies by Professor Klopp unequivocally show that as a result of the BEMER therapy, the activity of white blood cells intensifies, they progress “more slowly” along the blood vessel wall, providing enhanced protection against potential pathogens. The therapy strengthens the body’s own immune response, thus there are no adverse reactions which characterize medications. The strength of the magnetic field used in the therapy does not exceed 100 µT (1 G) as measured on the surface of the applicators. Consequently, it can be used in the case of metallic implants, pacemakers, and even pregnancy.

In the course of BEMER therapy, first the whole body is treated, which is followed by local application. The extremely wide choice of therapeutic devices enables the targeted, circular treatment of joints, or even the treatment of patients confined to bed and/or unable to move in their hospital wards with the help of a mobile device.

Figure 4. Impaired microcirculation /left/, 

healthy microcirculation /right/.

The advantage of the therapy is that it is easily available (the portable version can be purchased at a relatively advantageous price), it involves no pain, and does not require medical personnel after training (patients can operate it in their own home).

Medication therapy

The hyaline cartilage, which serves the articulation of bones, resists compressive force and shear stress, and it ensures appropriate flexibility due to the characteristic structure of cartilage tissue. Chondrocytes ensure the integrity and regeneration of the articular cartilage through the synthesis of matrix components. The fibrillar component of the extracellular matrix is made up by type-II collagen in 90-95%. The collagen fibre structure is embedded in a basic matter made up of proteoglycan macromolecules (hyaluronic acid-aggrecan complex). Glycosaminoglycan (GAG) molecules forming part of the hyaluronic acid-aggrecan have a high ability to bind water, and the 80% of the matrix is made up of water. The high water content keeps the collagen structure in an almost overstretched condition, which contributes to the flexible resistance of the articular cartilage. Glucosamine (made up of glucose and the amino acid called glutamine) is the precursor of the water binding gycosaminoglycan of the cartilage tissue matrix. Glucosamine is a physiological component of the extracellular matrix of the articular fluid and the cartilage. The administered glucosamine-sulfate gets into the systemic circulation and is transported to the target of its effect, the joint, where the chondrocytes build it into the components of the glycosaminoglycan chains of the cartilage tissue. At the same time, due to the beneficial structural changes which take place, glucosamine-sulfate alleviates the symptoms of osteoarthritis. Data taken from the literature prove that in the case of osteoarthritis, the administration of a daily dose of 1200 mg of glucosamine is recommended for the purposes of therapy. Pain is reduced, and so is the damage to the cartilage caused by strain. The additional administration of magnesium is also recommended to alleviate muscle cramps. 

When peripheral muscles are overloaded, structural changes occur in the muscles, as a result of which the muscles cannot be loaded or used to the maximum. If the muscles do not rest or do not have enough time to regenerate, higher muscle tone will develop because of the overstrain, or muscle shortening and various rheumatological complaints may occur. The BEMER therapy plays a part in solving these. Stretching and relaxing exercises are eminently suitable to relieve the cramped tension of muscles and to enhance microcirculation.

Damages to health caused by protective clothing and protective equipment can be prevented by appropriate preparation, and in this an important part is played by prevention, rehabilitation and health-centered thinking. The weight of the equipment makes the exploitation of the expensive technical equipment critical, and it hinders the quick movement and mobility of its user. Further development carried out regarding army practice apparel and personal equipment increase the efficiency of the soldiers and therefore their ability to win a fight. This does not only help in multiplying their strength, but also in exploiting the maximum efficiency of expensive weapons systems. Requirements concerning health and safety have become more important at the level of legislation as well, which resulted in the development of several new materials used for personal protection in industry as well. The effective improvement in firepower (e.g. laser- or computer-assisted grenade launchers) and direction systems (e.g. GPS) have increased the weight of military equipment. This can be expected to increase further in future (eg. digital battlefield). Health services can also contribute to reducing harmful effects. 

Date: 04/04/2018

Source: MCIF 4/2010