Osteopathic Correction Research Articles

Evaluation of the clinical effectiveness of osteopathic gallbladder drainage techniques

Introduction. In recent decades, a lot of new materials about etiology and pathogenesis of biliary system diseases have been obtained and new effective drugs have been introduced. But, despite this, there remains much unrecognized and controversial in etiopathogenesis and principles of treatment of the disease. Moreover, the frequency of complicated forms of the disease and the overall incidence of biliary pathology continues to grow, which clearly shows the need to search for new approaches to diagnosis and treatment of these conditions. The leading causes of biliary tract pathology formation, actual problems of pharmacotherapy (allergic reactions, side effects, polypragmasy), certain aspects of comorbid pathology make clinicians pay closer attention to non-medicament treatment methods, including osteopathic correction. Previous studies have already demonstrated a good clinical effect of osteopathic correction in the treatment of patients with biliary disorders. At the same time, most studies in osteopathy present an assessment of the possibility of using osteopathic correction in the treatment of certain nosological forms. But no less important, in our opinion, is to conduct studies aimed at evaluating the clinical effectiveness (efficiency) of individual osteopathic approaches and techniques.The aim of the study: to investigate the clinical effectiveness of osteopathic techniques of gallbladder drainage.Materials and methods. The study was conducted in 2022–2023 on the basis of Polyclinic of the Federation of Independent Trade Unions of Russia (Moscow) and City Mariinsky Hospital (St. Petersburg). There were 30 people (9 men and 21 women) aged 18 to 59 years (mean age was 40,4±2,3 years) without pathology of the gastrointestinal tract and gallbladder (biliary tract) who agreed to participate in the study. All participants underwent a fasting gallbladder volume study, followed by a gallbladder volume study one hour after eating a trial breakfast (TB). One week after the first study, the same patients underwent another fasting gallbladder volume study, then a gallbladder volume study after osteopathic correction (OC) techniques. Thus two observation groups were formed: observation 1 (TB) — study of gallbladder function before and after taking a trial breakfast; observation 2 (OC) — study of gallbladder function before and after gallbladder drainage techniques. Participants did not receive other treatments during the study. All respondents underwent clinical osteopathic examination and biliary ultrasound with motor function score (MFS) was performed. Outcomes in this study were defined as changes in gallbladder size and motility.Results. No global level somatic dysfunction was identified in the study participants. Regional biomechanical disorders and separate local somatic dysfunctions were more typical for them. However, it was not possible to identify any predominant dysfunctions, as all of them were detected in single cases. After the exposure was completed, the osteopathic status was re-evaluated. The analysis showed that there were no statistically significant changes in the frequency of detection of the main somatic dysfunctions in both observations (p>0,05). In the observed respondents, no abnormalities in the basic size and volume of the gallbladder at the beginning of the study were revealed. After the conducted stimulation no statistically significant differences in gallbladder size (length and width) both within and between the observation groups were registered (p>0,05), but statistically significant dynamics was obtained in the form of gallbladder volume decrease in response to the effect (p<0,05) both when using TB and after OC. All participants were assessed with a measure of gallbladder motor function (MFS). In case of observation 1 (TB), the MFS value was 0,66±0,09 and observation 2 (OC) was 0,58±0,07, which corresponds to normal gallbladder functional activity. Compared to the use of a trial breakfast, osteopathic correction demonstrated a slightly less pronounced effect on gallbladder motor function, but these differences between the groups were not statistically significant (p>0,05).Conclusion. Osteopathic manipulations on the gallbladder and biliary tract have an effect on the gallbladder volume and motor activity comparable to the effect of the trial breakfast.

Influence of a single osteopathic procedure on the regulatory processes of the body of premature infants (pilot study)

Introduction. The number of children born early in gestation and with low body weight and associated health disorders require the search for effective methods of rehabilitation treatment. The development of new effective non-invasive methods of rehabilitation/rehabilitation of premature infants is one of the priority tasks of national health care.Aims — to evaluate the effect of a single osteopathic procedure on the regulatory processes of the body (an indicator of the activity of regulatory systems and an index of nervous system tension) in premature infants.Materials and methods. In the clinic 30 premature infants with a gestation period of 24 to 37 weeks were monitored on the terms of voluntary written informed consent (the average gestation period was 31,35±0,45 weeks). The children were aged from 2 to 12 months (the average age was 4,93±0,45 months), of which 53,3 % (16 people) were boys and 46,6 % (14 people) were girls. On admission, parents most often complained about sleep disorders: sleep is not long, the child often wakes up at night or cries in his sleep, often sleeps only in the arms of his mother. It is difficult to feed the child, he does not eat the daily norm of food. During wakefulness, the child is restless, and when crying, calms down only in the arms. Osteopathic examination and correction were performed according to the clinical recommendations «Somatic Dysfunctions» and patent № 2739128 «Method of treatment of pain syndrome on the background of somatic dysfunctions in newborns». The procedures are carried out, as a rule, in the first half of the day, lasting 20 minutes. A methodical technique in the form of a single osteopathic procedure was used, when first the patient is examined, immediately after that the procedure and again the examination. The state of nervous system tension was assessed using cardiointervalography, the index of activity of the body′s regulatory systems and the index of tension of the autonomic nervous system were evaluated. The FLACC-SS pain assessment scale for infants, which we modified, was used to assess pain. Psychomotor development was assessed using the Griffiths developmental scale. The Statistica-10 software package was used for statistical analysis of the obtained data.Results. Upon admission, the pain level on the FLACC-SS scale was 2,35±1,35 points, which indicates, on average, moderate pain intensity in children. The Griffiths score was 31,64±3,57 points, which indicates a delay in psychomotor development in children. In the study of CIG before osteopathic correction, the IN was 597,77±89,99 units, and the PARS was 5,10±0,85 points. This is a pronounced functional stress of the body and is characterized by a decrease in its functional reserves and an inadequate response to environmental factors. During the initial osteopathic examination, somatic dysfunctions were detected mainly at the global level (changes in skeletal muscle tone, changes in cranial, cardiac and respiratory rhythms). After a single osteopathic correction procedure, the tension index decreased statistically significantly, and there was also a tendency to decrease the level of tension of regulatory systems. The pain level in children decreased to 0,16 points, which means.Conclusion. Somatic dysfunctions play an important role in the development of disorders of body regulation and pain syndrome. Correction of somatic dysfunctions in premature infants by osteopathy methods helps to reduce pain syndrome and improve the adaptive mechanisms of the body. Thus helps to prevent energy-consuming increased work of regulatory mechanisms, to adjust sleep and wakefulness, to improve appetite and, ultimately, the quality of life of the infant and the whole family. Restoring the energy balance of the child′s body, optimizing the work of regulatory systems, reducing the intensity of pain syndrome makes it possible to start early rehabilitation of premature infants.

Osteopathic correction in the complex treatment of women of reproductive age with pelvic organ prolapse

Osteopathic correction in the complex treatment of women of reproductive age with pelvic organ prolapse

Osteopathic correction in the complex therapy of children with astigmatism

Introduction. One of the current tasks of healthcare is the preservation of vision in children, prevention of blindness and visual impairment. In Russia, more than 1 million children suffer from visual impairments: myopia, hypermetropia, astigmatism, amblyopia. It is especially important to identify refractive errors and their complex correction in primary school children, since actual school loads are comparable in intensity to the visual loads of adults engaged in visually strenuous work. Osteopathic correction has proven itself well in the complex therapy of accommodative asthenopia of adult patients with visually strenuous work. However, the effectiveness of osteopathic correction in the complex treatment of accommodative asthenopia in children has not been sufficiently studied.The aim of the study was to evaluate the effectiveness of osteopathic correction in the complex therapy of children with astigmatism.Materials and methods. The study involved 40 children aged 7 to 11 years with the presence of simple, complex hypermetropic astigmatism, complex myopic astigmatism, mixed astigmatism. Two groups were formed: the control group — 20 children who received standard treatment (constant wearing of corrective glasses, pleopto-orthoptic treatment); the main group — 20 children who additionally received a course of osteopathic correction (3 sessions with an interval of 1 month). In each group, two subgroups were additionally identified: children with hypermetropic astigmatism, HA (16 in the main group and 15 in the control group), and children with myopic astigmatism, MA (4 in the main and 5 in the control group). The number of these subgroups was insufficient to test any statistical data on them hypotheses. In each subgroup, the osteopathic and ophthalmological (visual acuity, astigmatism, fatigue of the visual analyzer) status before and after therapy was evaluated in each group. Descriptive statistics were calculated for all subgroups based on the results of the study. Statistical hypotheses were tested in relation to subgroups of children with HA.Results. At the beginning of the study, 100 % of children with astigmatism had regional somatic dysfunctions of the head. Regional somatic dysfunction of the dura mater was detected in the main group in 69 % of children with HA and in 100 % of children with MA, and in the control group, respectively, in 73 and 100 %. After complex therapy, which included osteopathic correction, children with HA revealed statistically significantly (p<0,05) fewer cases of biomechanical disorders of the head regions and dura mater than children of the corresponding subgroup of the control group. Also, children with HA in the main group had statistically significantly (p<0,05) more pronounced positive dynamics in a number of indicators of ophthalmological status: an increase in visual acuity, a decrease in the magnitude of astigmatism. After complex therapy, children with HA were characterized by significantly (p<0,05) less pronounced fatigue of the visual analyzer.Conclusion. The results of the study indicate the effectiveness of the inclusion of osteopathic correction in the complex therapy in children with HA. At the same time, it is advisable to continue research in this direction with the study of more ophthalmological parameters and on a more representative sample.

Osteopathic correction in complex rehabilitation of children who have undergone cochlear implantation

Introduction. Currently, the only way to rehabilitate patients with deafness is cochlear implantation (CI). CI includes not only surgery, but also rehabilitation carried out by a whole group of specialists. This is a multi- stage, labor-intensive, complex, long-term process of developing and maintaining speech function, so there is a constant search for new approaches and methods that could increase the effectiveness of ongoing rehabilitation measures. Previous studies have demonstrated that osteopathic correction in preschool children reduces the severity of speech disorders, contributes to the regression of speech therapy disorders, and helps in the correction of certain forms of dysarthria. Of particular interest is the work in which the authors demonstrated the existence of relationships between certain somatic disfunctions and the presence of disturbances in peripheral sound conduction and/or central sound conduction in children with sensorineural hearing loss. The question of the possibility of using osteopathic correction in the rehabilitation of children with pathologies of hearing and speech function (since, in addition to the consequences of highly invasive surgical intervention, children who have undergone CI, as a rule, have delayed speech development), seems promising for study.The aim was to study the results of the use of osteopathic correction in the rehabilitation of children who have undergone CI.Materials and methods. A randomized controlled prospective study was conducted from March 2022 to December 2022 on the basis of the Federal State Budgetary Institution RNTSCAiS FMBA of Russia, FSBI NMCIO FMBA of Russia. 36 children aged from 17 to 37 months were under observation. Depending on the treatment used, all observed patients were divided into 2 groups using a simple randomization method: main (20 people) and control (16 people). Patients in both the main and control groups received standard rehabilitation treatment. Each patient of the main group additionally underwent a single session of osteopathic correction lasting from 45 to 60 minutes. All patients were assessed for osteopathic status, time of connection and adjustment of the cochlear implant, and quality of life.Results. In children after CI, global neurodynamic disorders and regional biomechanical disorders in the regions of the head, neck, and dura mater were most often detected. After treatment, only patients in the main group showed a statistically significant (p<0,05) decrease in the frequency of detection of both global neurodynamic and the above-mentioned regional biomechanical disorders. A single session of osteopathic correction contributes to a significant reduction in the time of connection and adjustment of the cochlear implant, which can be considered as a favorable factor for subsequent rehabilitation measures. Against the background of the ongoing rehabilitation, a statistically significant increase in the level of quality of life was obtained in both groups, however, in the main group this indicator was statistically significantly higher.Conclusion. For children who underwent CI, the most characteristic was the presence of a global neurodynamic disorder, as well as regional biomechanical disorders at the level of the head, neck and dura mater. A single session of osteopathic correction can significantly reduce the time of initial connection and adjustment of a cochlear implant, as well as improve the quality of life of this category of patients. This allows us to recommend the inclusion of osteopathic correction in comprehensive rehabilitation programs for children who have undergone cochlear implantation.

Обоснование применения остеопатической коррекции у пациентов с нарушением носового дыхания

Introduction
 Todate, the prevalence of breathing disorders in children and adults makes it necessary to modify diagnostic and therapeutic measures to improve the health status of patients. Currently, the question of whether complex treatment of comorbid patients affects their respiratory function remains open.
 Purpose
 To evaluate the effect of osteopathic correction of nasal breathing disorders in orthodontic patients with occlusion pathology.
 Materials and methods
 30 orthodontic patients with concomitant nasal breathing disorders underwent osteopathic correction of the nasal-frontal complex using the author's method (patent application 2023131610). The method of breathing assessment was spirometry with CONTEC SP80B device.The study standardization included the patient's sitting position; a maximal deep breath was taken through the nose with tight lips followed by a complete exhalation through the mouth into the tube of the device. For each patient, the vital capacity of the lungs (VC) was assessed before osteopathic treatment (FVC0), immediately after osteopathic treatment (FVC1) and in 1.5 months (FVC2) in order to assess the delayed outcomes of the osteopathic correction. Friedman's one-way analysis was used to test the statistical significance of differences between the groups, then the groups were compared in pairs with each other using the Nemenyi test. The overall significance level was taken as 0.5. The statistical criteria were calculated using the scipy version 1.9.1 and scikit-posthocs version 0.7.0 packages of the Python 3.10 programming language.
 Results
 The overall difference in the medians of all subjects in terms of vital capacity before and immediately after the osteopathic correction (FVC1 and FVC0) was 23%, and it was 26%inthe groups relative to the primary values (FVC2 and FVC0) in 1.5 months after the osteopathic correction.If we consider the male half of the patients, the median increase in vital capacity was 18% in 1.5 months after the intervention,while it was 31% in women.In patients under 20 years old, the median increase in vital capacityimmediately after the osteopathic correctionwas 26%, and in 1.5 months after the intervention, the median increase was another 6%; in patients over 20 years old, the increase in vital capacity was 11% immediately after the osteopathic correctionand another 5%in 1.5 months.
 Conclusion
 The osteopathic correction of dysfunctions of the frontal-nasal complex according to the author's method with acomprehensive approach improves nasal breathing, contributes to the normalization of general health status, posture, feet, and psychological state and improves the effect of orthodontic appliances in the treatment of malocclusion pathology.

The effect of complex treatment including osteopathic correction on pain intensity and quality of life in patients with chronic tonsillitis

Introduction. The relevance of the problem of chronic tonsillitis is due to the wide spread of the disease and the occurrence of complications associated with it, which, in turn, contributes to the appearance of pain and a decrease in the quality of life. Available information about the role of the palatine tonsils as an important organ of the immune system makes conservative treatment methods more preferable. Conventional conservative treatment is reduced to episodic implementation of individual techniques and remains insufficiently effective. Obtaining in-depth knowledge about the mechanisms of development of chronic tonsillitis necessitates the search for an integrated approach to treatment including non-drug methods. Often, questions about the severity of pain in patients that affect the level of quality of life are not given due attention.The aim is to study the effect of complex treatment including osteopathic correction on the quality of life and intensity of pain in patients with chronic tonsillitis.Materials and methods. In a prospective controlled randomized study conducted at the Department of Osteopathy and the Department of Otorhinolaryngology of the North-Western State Medical University named after I. I. Mechnikov of the Ministry of Health of Russia in the period from 06.2022 to 06.2023, 60 patients with a diagnosis of chronic tonsillitis were included. All patients, depending on the treatment, were divided using the randomization envelope method into two groups — main (n=30) and control (n=30). Patients in both groupsreceived otorhinolaryngological treatment in the form of lavage of the palatine tonsils (five rinsing procedures using an antiseptic solution, the interval between procedures was 2 days). Patients in the main group additionally received osteopathic correction (three procedures with an interval of 14 days). In all patients, before and after completion of treatment, the intensity of pain was assessed using a visual analogue scale (VAS) and quality of life using the SF-36 questionnaire.Results. In patients of both the main and control groups, there was a statistically significant decrease in the intensity of sore throat (p<0,05) after treatment. The increase in the level of quality of life in terms of both physical and psychological components of health was statistically significant (p<0,001) in patients of the main group. The level of quality of life in patients in the control group increased only due to the psychological component (p<0,001) of health, and the indicators of the physical component did not change (p=0,092).Conclusion. The inclusion of osteopathic correction in the complex therapy of patients with chronic tonsillitis in the inter-relapse period helps to reduce the pain and improve the physical component of quality of life compared to traditional conservative treatment alone. The study should be continued with a larger sample.

Rehabilitation after severe haff disease

The article presents a description of the effectiveness of complex rehabilitation of a patient after a severe of Gaff′s disease with an osteopathic diagnosis: Global neurodynamic disorder (impaired production of the cranial rhythmic impulse). The patient was assigned a rehabilitation plan, the objectives of which were to increase exercise tolerance up to 30 minutes, as well as adaptation to aerobic exercise: osteopathic correction; locomotor regimen; active verticalization; breathing exercises, exercise therapy, articular exercises, cardiac loading, as well as the expansion of the locomotor regimen after consulting of the therapist and physician. The rehabilitation helped to improve the general condition, reduce the severity of ataxic syndrome and stabilize hemodynamics. Osteopathic assistance provided within the framework of interdisciplinary cooperation allowed to improve blood circulation and innervation, which, in turn, increased the effectiveness of rehabilitation measures. Patients after a severe course of Gaff′s disease are shown to carry out rehabilitation measures with the involvement of osteopathic doctors as part of the rehabilitation team.

The effect of myofascial techniques on the electrical activity of the neck muscles

Introduction. Research by foreign scientists often present the results of studies of the effects of specific osteopathic techniques on the body. Myofascial techniques are dynamic low-amplitude techniques in which the myofascial complex of tissues is rhythmically stretched in areas where their mobility is limited. In one study of paravertebral muscles using surface electromyography (sEMG) before and after myofascial techniques, a statistically significant (p<0,05) decrease in their electrical activity was obtained. No publications devoted to the study of the effect of myofascial techniques on the electrical activity of the neck muscles were found.The aim is to study the effect of myofascial techniques on the electrical activity of the neck muscles in individuals with increased tone of these muscles.Materials and methods. A prospective study was conducted in the Department of Osteopathy of Mechnikov North-West State Medical University in which 30 apparently healthy volunteers who did not present active complaints, aged from 23 to 35 years, took part, with a median of 25 years. Inclusion criteria were palpation-determined increased tone of the sternocleidomastoid and upper trapezius muscles. Non-inclusion criteria were the presence of diseases and/or conditions that are an absolute contraindication to osteopathic correction, a history of neck injuries; taking medications that affect muscle tone at the time of the study; neuromuscular diseases. At the beginning of the study, all volunteers underwent palpation of the upper trapezius and sternocleidomastoid muscles on both sides. The degree of increase in muscle tone was assessed in points: 1 — weak; 2 — medium; 3 — strong; 0 — normal tone. Next, they underwent myofascial mobilization techniques: longitudinal and unilateral lateral mobilization of the soft tissues of the neck, separate mobilization of the sternocleidomastoid muscles. Before, immediately after, and three days after the session, muscle tone was recorded using surface electromyography (sEMG), which was performed on a wireless monitoring complex for electrophysiological signals «Kolibri» (OOO NMF «Neurotech», Russia). At rest, the average and maximum amplitude of electrical activity of the sternocleidomastoid and upper trapezius muscles was measured. The recording was made synchronously from the right and left sides of the body.Results. The sEMG indices of muscles with different tone based on the results of subjective assessment were statistically highly significant (p=0,0001). Moreover, according to the A(avg) indicator, the range diagrams either did not intersect or intersected only slightly. The electrical activity of the sternocleidomastoid muscles after myofascial mobilization techniques decreased statistically significantly and remained at the same level for 3 days (p=0,01). Such dynamics were observed in both the average and maximum amplitude of electrical activity. The amplitude of electrical activity of the right sternocleidomastoid muscle was slightly greater than that of the left (all subjects were right-handed), but these differences did not reach statistical significance (p>0,05). After treatment, there was a trend towards a decrease in the asymmetry of electrical activity between the left and right sternocleidomastoid muscles, both middle and maximum, but these changes were not statistically significant (p>0,05). The electrical activity of the upper part of the right trapezius muscle decreased statistically significantly after treatment and remained at this level for 3 days (p=0,01). The left trapezius muscle was excluded from the study due to technical reasons.Conclusion. The study showed that osteopaths (who are completing residency training in osteopathy) palpably distinguish between normal muscle tone and its increase in weak and moderate degrees. One session of myofascial mobilization techniques leads to a decrease in the tone of the sternocleidomastoid muscles and the upper part of the right trapezius muscle according to sEMG. Such changes occur immediately after the session and then persist for at least three days in young people with increased tone of these muscles. Surface electromyography can be used to objectively record and measure the results of specific osteopathic techniques. This is important for increasing the evidence of clinical research in osteopathy.

Change in the functional activity of fibroblasts in patients with coronavirus infection (history of SARS-CoV-2)

Introduction. In the genesis of the formation of somatic dysfunction, the leading role is given to adaptive reactions on the part of the body as a whole and connective tissue in particular. The main cells of connective tissue are fibroblasts, which have an important role in the formation of the structural and functional characteristics of connective tissue. There is an opinion that after a coronavirus infection, the adaptive activity of fibroblasts changes in response to external influences.The aim is to study changes in the functional activity of fibroblasts during a simulated compression effect on a culture of fibroblasts obtained from patients who suffered coronavirus infection 3–6 months before the experiment.Materials and methods. Under experimental conditions (in vitro), compression conditions were simulated in relation to a culture of fibroblasts taken from patients who had suffered a coronavirus infection (with a history of SARS-CoV-2) and patients who had no history of coronavirus infection.Results. Under experimental conditions, it was found that fibroblasts from patients who have suffered coronavirus infection have altered functional activity, manifested by a decrease in secreted glycosaminoglycans, elastin and collagen in response to in vitro modeling of the compression factor.Conclusion. The established response of fibroblasts to compression allows us to justify the need for priority elimination of this factor as part of osteopathic correction in patients who have suffered coronavirus infection during treatment and rehabilitation.

The possibility of reversibility of liver fibrosis under the influence of complex treatment

Endogenous intoxication is a pathological process that develops with the predominance of the formation or intake of toxins over their excretion. Pathological changes occur in the organs of excretion: in the liver, kidneys, lungs, gastrointestinal organs, on the skin. Chronic intoxication leads to chronic inflammation and fibrosis of target organs, i. e. to a violation of the architectonics of connective tissue. Until recently fibrosis was considered as an irreversible process, and it reduced the interest to its early diagnosis. Currently, there is an opinion that fibrosis is potentially reversible at certain stages. Using ultrasound elastometry, it is possible not only to confirm the presence of fibrosis, but also to quantify the degree of its severity. The article describes a case of a decrease in the severity of liver fibrosis in a comorbid patient with chronic hepatitis C under the influence of complex treatment with the inclusion of osteopathic correction.

The use of osteopathic correction in the treatment of patients with sciatic neuropathy

Introduction. In recent years, the interest of the medical community in peripheral neuropathies has significantly increased and great progress has been achieved in studying certain issues of etiopathogenesis and treatment of these conditions. The basis of therapy for piriformis syndrome (PS), as a particular form of sciatic neuropathy, is still drug therapy, but its use does not always lead to the desired results. This dictates the need to search for new, primarily non-drug, therapies as a part of the cumulative treatment of this disease. Previous work has demonstrated the possibilities of using reflexology, physiotherapy in the treatment of PS. Manual therapy has also been successfully used for a long time in the treatment of patients with this nosology, but most often only in the form of local approaches. In the available literature, there were no works evaluating the possibilities of using personalized osteopathic correction in this group of patients, as well as objectification of the complex treatment performed using ultrasound scanning. All of the above has predetermined the purpose of our research. The aim of the study was to study the results of complex therapy of patients with sciatic neuropathy (SP) with the inclusion of osteopathic correction. Materials and methods. A controlled randomized trial was conducted in the period from November 2020 to January 2022 on the basis of the profile medical clinic of LLC «Mokhov Institute of Osteopathy». We observed 22 patients aged 18 to 44 years with a diagnosis of sciatic neuropathy. Depending on the treatment used, all the observed patients were divided into the main (11 people) and control (11 people) groups using the simple randomization method. Patients of both groups received pharmacotherapy, and patients of the main group additionally underwent osteopathic correction (3 sessions with an interval of 8–10 days). All patients were assessed for osteopathic status, severity of pain syndrome and ultrasound diagnostics with assessment of the condition of the involved sciatic nerve. Evaluation and measurements were carried out before the start of treatment and 30 days after its start. Results. In patients with sciatic neuropathy, regional biomechanical disorders of the regions were most often detected: pelvis, structural and visceral components (45,5 % and 68,2 % respectively), dura mater (59,1 %), lumbar, visceral component (45,5 %). Among the local somatic dysfunctions (DM), the dysfunction of individual vertebral-motor segments was most often determined at the level of the cervical (18,2 %), thoracic (18,2 %) and lumbar (22,7 %) spine, individual joints of the lower extremities (22,7 %), individual skull sutures (27,3 %). After treatment, only in patients of the main group, a statistically significant (p<0,05) decrease in the frequency of detection of regional biomechanical disorders of the pelvic region (structural and visceral component), TMO was obtained. For the rest of the SD, the differences were not significant. The examined patients were characterized by moderate pain syndrome. The therapy, both with and without osteopathic correction, has shown good results. In patients of both groups, there was a significant (p < 0,05) decrease in the intensity of pain syndrome, but in the main group these changes were significantly more pronounced. Patients with sciatic neuropathy were characterized by an increased thickness of the nerve and a decrease in its echogenicity according to the results of ultrasound diagnostics. Against the background of therapy, patients of both groups have a decrease in nerve thickness, but in the main group these changes were statistically significant (p < 0,05) more pronounced. But normalization of nerve echogenicity was observed only in patients of the main group who received osteopathic correction (significant changes, p < 0,05). Conclusion. The use of osteopathic correction in the framework of complex therapy of patients with sciatic neuropathy allows to achieve a statistically more significant reduction in the intensity of pain syndrome and normalization of nerve structure (according to ultrasound data) compared with the isolated use of drug therapy. It is advisable to continue the study on a larger sample of patients.

The effect of general osteopathic treatment on muscle tone according to electromyography data

Introduction. Clinical research in osteopathy is criticized for the lack of standardization of treatment and insufficient use of instrumental methods to assess its effectiveness. Therefore, in order to increase evidence in osteopathy, it is relevant to search for instrumental methods that allow recording and measuring objective indicators and their changes after standardized osteopathic correction. The aim of the study is to research the effect of general osteopathic treatment on muscle tone using electromyography in practically healthy people. Materials and methods. A study was conducted on the basis of the Department of Osteopathy of the Mechnikov NWSMU. 30 practically healthy volunteers without any active complaints, aged 20 to 42 years (median 25 years), took part in the study. The criteria for non-inclusion were the presence of diseases and/or conditions that are an absolute contraindication to osteopathic correction, taking muscle relaxants or acetylcholinesterase inhibitors, diseases belonging to the G00-G83 group according to ICD-10, the presence of a trauma history for less than 1 year. All volunteers underwent general osteopathic treatment (GOT) as a standardized variant of osteopathic correction. Before and immediately after the GOT, muscle tone was studied using surface electromyography (sEMG), which was performed on the complex of wireless monitoring of electrophysiological signals «Kolibri» (manufacturer LLC «Neurotech», Russia). At rest, the average amplitude of the electrical activity of the muscles of the upper arms, the interscapular region, the anterior and posterior muscle groups of the thigh and lower legwere measured. The recording was made simultaneously from several muscle groups, synchronously from the right and left sides of the body. Results. After the GOT, a statistically significant decrease in the average amplitude of the thigh anterior surface muscles electrical activity from the median of 8 MV to 4 MV (p = 0,00001), the lower leg anterior surface from the median of 9 MV to 7 mv (p = 0,008) was detected, which indicates their relaxation. The tone of the other muscle groups did not change statistically significantly. The asymmetry of the average amplitude of electrical activity was observed in the studied muscles, which shows an imbalance of tone between symmetrical muscles. In most of the studied muscle groups, this indicator did not change statistically significantly after the GOT. And only in the anterior thigh muscle group, the asymmetry of the average amplitude of electrical activity decreased statistically significantly from the median of 7 MV to 2 MV (p = 0,0046). Conclusion. With the help of the sEMG, it was found that one session of GOT leads to a decrease in the tone of the anterior thigh and lower leg muscle groups, as well as a decrease in the asymmetry of the tone of the anterior thigh muscle group. These results can be explained from the standpoint of the GOT effect on skeletal muscles by means of improving the characteristics of the muscle tissue itself and the surrounding fascia, as well as by inhibitory and harmonizing effects on the nervous system, which ensures the maintenance and regulation of muscle tone. Surface EMG can be used to objectively record and measure the results of osteopathic correction to increase the evidence of clinical trials in osteopathy.

Vertebrogenic Pain Syndrome in Adolescents with Orthopedic Pathology, Aspects of Therapy

Relevance. Pain in the cervical, thoracic and lumbar spine is relevant not only for adults, but also for children and adolescents. Scoliosis is a predisposing factor for the development of pain syndrome in the back. Osteopathic techniques allow to expand the arsenal of methods in order to increase the effectiveness of treatment of patients with back pain.The aim of the study was to evaluate vertebrogenic pain syndrome in adolescents undergoing outpatient treatment with the diagnosis of dorsalgia. Materials and Methods: An observational study was conducted to analyze 157 case histories of adolescents (95 (60.5%) girls and 62 (39.5%) boys) undergoing outpatient treatment for dorsalgia diagnosed between the ages of 8 and 17 years. The reliability of differences between the studied groups was assessed by frequency analysis, using Pearson's Chi-squared criterion. All obtained differences were considered at a significance level not lower than p?0.05. Results. Among the 157 patients studied, orthopedic pathology (scoliosis of the spine, cervical instability, rotational subluxation of C1-C3, wedge deformity of the thoracic spine, L5 antelisthesis, Spina bifida S1) was diagnosed in 76 (48.4%) patients. Thoracic scoliosis of the 2nd degree was significantly more common in girls (p=0.043). L5 antelisthesis was significantly more common in boys (p=0.019). Lumbar scoliosis of the 2nd degree was significantly more frequent in the group of patients with moderate pain syndrome (VAS 4-6 points) (p=0,001). The cause of low back pain syndrome in 61 (38.9%) adolescents was benign musculoskeletal pain without orthopedic pathology. Conclusion: Vertebrogenic pain syndrome is one of the most frequent reasons for seeking outpatient medical care in adolescents. Detection of orthopedic pathology (scoliosis, instability, wedge deformity of vertebrae) against the background of pain syndrome requires examination by a neurologist, orthopedist and osteopath. The basis of therapy and prevention of back pain in adolescents is non-medication therapy, including osteopathic correction. Osteopathic correction is indicated in the detection of somatic dysfunctions.

Change in the clinical status of a patient with dysfunction of the temporomandibular joint after osteopathic correction of somatic dysfunctions

The described clinical case shows positive results of osteopathic correction in the complex treatment of syndrome of pain dysfunction of the temporomandibular joint (DTMDJ). Diagnosis and treatment of this syndrome attract attention because of the ambiguity of the etiology, pathogenesis and lack of effectiveness the treatment algorithm to achieve a stable result. In order to increase the adaptive capabilities of the body to the changes occurring in the stomatognathic system in the treatment of DTMDJ, we have developed and put into practice an interdisciplinary principle of diagnosis and treatment, which consists in an objective assessment of the clinical manifestations of somatic dysfunctions and their elimination before the start of dental intervention, which is carried out with adequate osteopathic support, leveling the increased load on the adaptation mechanisms. The dental intervention itself is carried out with adequate osteopathic support, leveling the increased load on the adaptation mechanisms. Interdisciplinary interaction allows you to optimize the approach to dental treatment.

Study of the possibility of using osteopathic correction for the treatment of patients with non-erosive gastroesophageal refl ux disease

Introduction. Gastroesophageal refl ux disease (GERD) is a chronic relapsing disease characterized by regularly repeated refl ux of gastric and, in some cases, duodenal contents into the esophagus. The urgency of the GERD problem is due to the widespread prevalence of this disease, a signifi cant decrease in the life quality and working capacity of patients, and it leads to signifi cant material losses and increases the risk of complications with long-term use of proton pump inhibitors. There is evidence of the effectiveness of osteopathic correction as a non-drug method as part of the complex treatment of non-erosive GERD. However, taking into considertion the potential risk of complications (osteoporosis and fractures, vitamin B12 and iron defi ciency, dementia, hypomagnesemia, impaired renal function, infectious complications, neoplasms, cardiovascular complications) caused by the use of the drugs′ treatment of GERD, it is in demand to search for evidence of the effectiveness of osteopathic correction as monotherapy for non-erosive GERD. The aim of the study was to investigate the possibility of using osteopathic correction as a monotherapy for the treatment of patients with non-erosive GERD. Materials and methods. The study involved 26 patients with non-erosive form of GERD. The age of patients was from 22 to 50 years old. Using the method of randomization envelopes, the two groups were formed (control and main). There were 13 patients (4 females and 9 males) in each group. All the study participants were prescribed a correction of the diet and regime of work and rest. Participants in the control group received basic drug therapy according to the Guidelines of the Russian Gastroenterological Association for the diagnosis and treatment of GERD. The dosage and duration were selected individually depending on the clinical manifestations and their duration. Participants of the main group received a course of osteopathic correction (2 sessions with an interval of 12–14 days). All participants underwent an esophagogastroduodenoscopy (EGD) examination at the start of the study. Before and after the treatment in both groups, the severity of GERD symptoms was assessed using the GerdQ questionnaire, as well as osteopathic status was estimated. In addition, we studied the relationship between the structure of dominant somatic dysfunctions (SD) and some indicators of the state of the esophagus and stomach, measured as part of an EGD examination: the cardia of the esophagus and stomach (closes, closes incompletely), transcardial migration of the stomach folds during calm breathing (yes, no), Hiss angle (acute, smoothed), the arch of the stomach during calm breathing (shifts, shifts to a limited extent), the shape of the arch of the stomach (normal, fl attened), the contents of the stomach (usual, with an admixture of bile). Results. The use of an osteopathic correction course for patients with a non-erosive form of GERD is accompanied by a statistically signifi cant (p<0,05) decrease in the severity of symptoms of the disease, assessed by the GerdQ questionnaire. The achieved indicators (the severity of symptoms of the disease, assessed using the GerdQ questionnaire) do not statistically signifi cantly differ from those achieved using standard drug therapy. The course of osteopathic correction is accompanied by a statistically signifi cant (p<0,05) decrease in the severity of biomechanical disorders of the thoracic region. A signifi cant correlation was established between the presence of dominant SD in the thoracic region and the presence of some features of the esophagus and stomach state (incomplete closure of the cardia of the esophagus and stomach, transcardial migration of the stomach folds during quiet breathing, a fl attened Hiss angle, a limited displacement of the gastric fornix during quiet breathing, a fl attened shape of the gastric fornix). Conclusion. The obtained results allow to consider the possibility of using osteopathic correction as a monotherapy for patients with non-erosive GERD. However, it is recommended to continue research in this direction on a larger sample size and using instrumental methods of examination in dynamics.

The possibilities of osteopathic correction using for the treatment of children with attention defi cit hyperactivity disorder

Introduction. Attention defi cit hyperactivity disorder (ADHD) is diagnosed in childhood and is the most common mental disorder in children — about 5–7 % among school-age children. None of the treatment methods, as clinical observations showed, is completely effective for the treatment of ADHD. In most cases, the main method of treatment is pharmacotherapy. But despite the proven short-term effectiveness, pharmacotherapy may have limitations: partial response or no response, side effects, questionable long-term benefi ts, poor adherence to the treatment regimen, negative attitude of parents. Limitations of existing pharmacological treatment methods emphasize the need to develop effective non-pharmacological interventions that improve short- and long-term results in regard to neuropsychological defi ciency symptoms and disorders of other general activity fi elds. Currently, there are publications noting the positive clinical effect of osteopathic correction on the children′s health state in various mental sphere disorders. But only a few studies are aimed at studying the effect of osteopathic correction in ADHD. At the same time, there are no publications about the osteopathic correction use in the ADHD treatment without pharmacotherapy.The aim of the study is to investigate the possibility of osteopathic correction using for the treatment of children with attention defi cit hyperactivity disorder.Materials and methods. The study was conducted on the basis of the medical organization «Health′ Clinic» Tver from March 2021 to February 2022. Inclusion criteria: children age 7–10 years; established ADHD diagnosis; absence of diseases and conditions that are an absolute contraindication for osteopathic correction; parental consent to osteopathic examination and correction. Criteria for non-inclusion: age of children younger than 7 and older than 10 years; not confi rmation of the diagnosis according to the «ADHD Assessment Scale — ICD-10 criteria»; the presence of diseases and conditions that are an absolute contraindication for osteopathic correction. Exclusion criteria: failure to attend repeated examinations. The total number of children was 38 people. The patients were distributed by randomization envelopes into 2 groups of 19 people each. The main group: the osteopathic correction and the behavioral psychotherapy were used. The comparison group: the drug hopanthenic acid and the behavioral psychotherapy were used. Before and after the treatment, osteopathic status was assessed in both groups, and the severity of ADHD was assessed according to the ADHD assessment scale (ICD-10 criteria), and an attention test was conducted in the form of a Bourdon correction test.Results. At the beginning of the study, the patients were characterized by regional biomechanical disorders of the head region — in 100 % of participants in both groups, as well as the neck (structural component) — in 63 % of participants in both groups, and the dura mater — in 89 % of participants in the comparison group and 79 % of the main group. After the course of treatment, a signifi cant (p<0,05) positive dynamics was observed in the main group according to the three above indicators, and there was no signifi cant dynamics in the comparison group. After the treatment, the statistically signifi cant (p<0,05) positive dynamics was observed in both groups with respect to the severity of ADHD and the main characteristics of attention: the indicators of the ADHD assessment scale (ICD-10 criteria) decreased, the accuracy coeffi cients and concentration of attention increased, and the fatigue index decreased. At the same time, in the main group, the fatigue index decrease was statistically signifi cant (p<0,05) more pronounced than in the comparison group.Conclusion. The obtained results allow us to recommend osteopathic correction in the treatment of children with ADHD, especially in the cases where, for some reasons, there are restrictions on the medications use.

Infl uence of osteopathic correction on range of motion and quality of life in patients with arthrosis of the shoulder joint of I–II degrees

Introduction. Shoulder pain in the shoulder joint arthrosis is a diffi cult problem to treat. The search for effective therapy of the shoulder region pathology is an urgent medical and socio-economic task, since the peak of morbidity is during the period of active human labor activity — 40 years. As a rule, nonsteroidal anti-infl ammatory drugs and glucocorticoid drugs are used to treat patients with shoulder pain syndrome and arthrosis of the shoulder joint of I–II degrees, but it is associated with potential risk of adverse reactions. Therefore, the search for non-drug methods of treatment is in demand. Osteopathic correction has proven itself well in the complex therapy of a number of degenerative joint diseases and pain syndrome. At the same time, there are currently few works devoted to the problem of restoring function in the shoulder joint and the life quality of a patient with the shoulder joint arthrosis of I–II degrees from the position of osteopathic correction. The aim of the study was to investigate the effect of osteopathic correction on the motion range and life quality of patients with the shoulder joint arthrosis of I–II degrees.Materials and methods. The study involved 26 patients with arthrosis of the shoulder joint of I–II degrees. The study was conducted from January 2020 to December 2021 at the «Tuya» Center of Traditional Medicine, Ufa. Using the method of randomization envelopes in a ratio of 1:1, there were formed two groups: control (13 patients) and main (13 patients too). All participants received standard conservative treatment. The participants of the main group additionally received a course of osteopathic correction (3 sessions, an interval is 2–3 weeks, and the duration of treatment is 1–2 months). Before and after the treatment, there were assessed the pain syndrome intensity using a 10-point visual-analog scale, the motion range in the diseased joint using a goniometer, the severity of pain syndrome and limitations in the shoulder joint using the Oxford Shoulder Score questionnaire, the life quality using the SF-36 questionnaire, and the osteopathic status according to approved clinical recommendations.Results. Standard treatment of patients in the control group was accompanied by a statistically signifi cant (p<0,05) decrease of the pain syndrome intensity, an increase of the motion range in the shoulder joint and a decrease of restrictions in the shoulder joint area. The inclusion of a osteopathic correction course in the treatment was accompanied by a statistically signifi cant (p><0,05) more pronounced positive dynamics in all of these indicators. In addition, patients of the main group were characterized by a signifi cant (p><0,05) improvement in the life quality by all indicators according to the SF-36 questionnaire. In most of the examined patients, the regional somatic dysfunctions (SD) of the thoracic region (structural and visceral components), and the dura mater region were revealed. In 100 % of patients, local SD of the shoulder joint were detected. The course of osteopathic correction was accompanied by a signifi cant (p><0,05) decrease of the detection frequency of thoracic region and dura mater regional SD, and of the local SD of the shoulder joint. There was no signifi cant dynamics in the control group. Conclusion. It is recommended to include a course of osteopathic correction in the complex treatment of patients with arthrosis of the shoulder joint of I–II degrees.><0,05) decrease of the pain syndrome intensity, an increase of the motion range in the shoulder joint and a decrease of restrictions in the shoulder joint area. The inclusion of a osteopathic correction course in the treatment was accompanied by a statistically signifi cant (p<0,05) more pronounced positive dynamics in all of these indicators. In addition, patients of the main group were characterized by a significant (p<0,05) improvement in the life quality by all indicators according to the SF-36 questionnaire. In most of the examined patients, the regional somatic dysfunctions (SD) of the thoracic region (structural and visceral components), and the dura mater region were revealed. In 100 % of patients, local SD of the shoulder joint were detected. The course of osteopathic correction was accompanied by a signifi cant (p<0,05) decrease of the detection frequency of thoracic region and dura mater regional SD, and of the local SD of the shoulder joint. There was no signifi cant dynamics in the control group.Conclusion. It is recommended to include a course of osteopathic correction in the complex treatment of patients with arthrosis of the shoulder joint of I–II degrees.

Pressure force on tissues in various osteopathic techniques (pilot study)

Introduction. The main tool of the osteopathic physician, which carries out most of the diagnostic and therapeutic actions, is the hands. To conduct scientifi c research in osteopathy, it is necessary to understand the nature of the impact and its quantitative characteristics, in particular, the pressure force of the physician′s hands on the patient′s body. In the available literature, it was possible to fi nd single instrumental studies of the pressure force of the osteopath′s hands during performing cranial techniques. Similar studies about the performance of other techniques could not be found in the available literature.Aims: to measure by an instrumental method the pressure force of the osteopath hands during various osteopathic techniques (cranial, visceral, structural).Materials and methods. The study was conducted on the basis of the Mokhov Institute of Osteopathy Clinic in January 2023. The study involved 6 lecturers of the Institute of Osteopathy (St. Petersburg), their experience as an osteopath is at least 5 years; the age is from 33 to 53 years. As patients, the residents of the Osteopathy Department of Mechnikov North-West Medical State University were involved. There were 2 men and 4 women, aged from 24 to 26 years, with a normosthenic constitution and a body mass index from 19,5 to 24. The following devices were used to measure the pressure strength of the osteopathic physician′s hands: Fsr402 resistive pressure sensors (Arduino Italy) and A402 (Tekscan USA), FlexiForce Prototyping Kit with FlexiForce MicroView software (Tekscan USA), and a device for determining skin elasticity and human skin scars (strain gauge attached to a caliper, Patent RU 2763 843 C1). Each physician demonstrated several osteopathic techniques on one patient. During the execution of each technique, three measurements were made, and the arithmetic mean was calculated. Structural, visceral and cranial techniques of osteopathic correction were performed.Results. The Friedman test showed a statistically signifi cant difference in pressure strength for different techniques (p<0,01). The greatest pressure force was measured during the mobilization of the descending colon (3,6±0,3 Newton); the minimum force was measured during the mobilization of the thoracic spine in the extension (1,5±0,3 Newton). When performing each technique, there was a range (the difference between the minimum and maximum values) between physicians from 0,95 Newton for performing a frontal bone lift to 1,8 Newton for mobilizing the sigmoid colon. Conclusion. The pilot study showed that during performing different techniques, the pressure strength of the osteopathic physician′s hands differed signifi cantly. It is advisable to continue the study on a more representative sample.> <0,01). The greatest pressure force was measured during the mobilization of the descending colon (3,6±0,3 Newton); the minimum force was measured during the mobilization of the thoracic spine in the extension (1,5±0,3 Newton). When performing each technique, there was a range (the difference between the minimum and maximum values) between physicians from 0,95 Newton for performing a frontal bone lift to 1,8 Newton for mobilizing the sigmoid colon.Conclusion. The pilot study showed that during performing different techniques, the pressure strength of the osteopathic physician′s hands differed signifi cantly. It is advisable to continue the study on a more representative sample.

Somatic Dysfunction. Clinical Guidelines 2023

The aim is to present for osteopaths the modern ideas about somatic dysfunctions as potentially reversible structural and functional disorders in the human body, and about its diagnostics and the correction possibilities.A specifi c subject of osteopathic infl uence is a group of palpable phenomena, which are called somatic dysfunctions. Somatic dysfunctions are included in the International Classifi cation of Diseases, Injuries and Conditions Affecting Health, 10th Revision (ICD-10). Somatic dysfunction (SD) is a potentially reversible structural and functional disorder in tissues and organs, manifested by palpation-determined limitations of various types of movements and mobility. Reversibility is one of the main characteristics of SD, associated with the ability to obtain the effect of changing/eliminating the identifi ed disorders in response to various methods of osteopathic correction. Impaired mobility, that is, SD, can have several components that can be combined with each other and have different degrees of severity — biomechanical, hydrodynamic (rhythmogenic) and neurodynamic. SD can manifest itself at the global, regional and local levels, and can have an acute or chronic character. The leading role in the pathogenesis of SD formation belongs to the connective tissue. Based on anamnestic data, physical examination, as well as using the algorithm of palpation diagnostic techniques, osteopaths determine the relative position of the body structures and their symmetry, as well as the qualitative state of the tissues. In addition to the generally accepted formulation of the diagnosis, an osteopathic conclusion includes the indication of biomechanical, rhythmogenic and neurodynamic disorders at the global, regional and local levels, as well as the dominant SD, the correction of which will be the logical ultimate goal of the osteopathic session. In accordance with the current regulatory framework, the osteopathic physician at the appointment fi lls out the form «Primary examination by an osteopathic physician» or the form «Examination by an osteopathic physician (observation in dynamics)». These medical documents are an insert in the Registration Form № 025/u, approved by the order of the Ministry of Health of Russia dated December 15, 2014 № 834n. The restoration of mobility is the goal of osteopathic treatment techniques applying and leads to the normalization of the functional state of tissues. The practice of osteopathy is to release the elements of the musculoskeletal system, internal organs, to restore the proper functioning of all body systems, including the nervous, circulatory and lymphatic systems. In the absence of contraindications (absolute or relative), the treatment regimen is determined individually in accordance with the issued osteopathic conclusion, including the defi ning of the number, nature (type) of techniques and the sequence of their use in a given session. The effectiveness of osteopathic correction of SD has been proven for various diseases and conditions, a list of which is also presented in the Recommendations.Conclusion. The implementation of the Clinical Recommendations can contribute to the timely diagnosis and improve the quality of medical care for patients with SD.