rojournalРоссийский остеопатический журналRussian Osteopathic Journal2220-09752949-3064All-Russian Public Organization «Russian Osteopathic Association» (ROsA)10.32885/2220-0975-2026-3-180-209rojournal-836Research ArticleОБЗОРЫREVIEWSРезультаты немедикаментозного лечения нарушений постурального балансаOutcomes of non-pharmacological treatments for postural balance disordershttps://orcid.org/0000-0001-8674-5633ПотехинаЮ. П.PotekhinaYu. P.

Юлия Павловна Потехина , докт. мед. наук, профессор, профессор кафедры нормальной физиологии им. Н. Ю. Беленкова;

заместитель директора по научно-методической работе;

кафедра остеопатии с курсом функциональной и интегративной медицины, профессор

Scopus Author ID: 55318321700

603000, Нижний Новгород, пл. Минина и Пожарского, д. 10/1;

191024, Санкт-Петербург, ул. Дегтярная, д. 1, лит. А;

191015, Санкт-Петербург, Кирочная ул., д. 41

Yulia P. Potekhina , Dr. Sci. (Med.), Professor, Professor at the N. Yu. Belenkov Department of Normal Physiology;

Deputy Director for Scientifi c and Methodological Work;

Department of Osteopathy with a Course of Functional and Integrative Medicine, Professor

Scopus Author ID: 55318321700

bld. 10/1 pl. Minin and Pozharskiy, Nizhniy Novgorod, 603005;

bld. 1 lit. A ul. Degtyarnaya, Saint-Petersburg, 191024;

bld. 41 ul. Kirochnaya, Saint-Petersburg, 191015

newtmed@gmail.comЯковлевД. К.YakovlevD. K.

Даниил Константинович Яковлев , кафедра остеопатии с курсом функциональной и интегративной медицины, ординатор

191015, Санкт-Петербург, Кирочная ул., д. 41

Daniil K. Yakovlev , Department of Osteopathy with a Course in Functional and Integrative Medicine, Resident

bld. 41 ul. Kirochnaya, Saint-Petersburg, 191015

https://orcid.org/0009-0003-9740-9557ПолисмакО. В.PolismakO. V.

Олег Валерьевич Полисмак , канд. мед. наук, Центр физической и реабилитационной медицины, врач физической и реабилитационной медицины, врач-остеопат

344011, Ростов-на-Дону, ул. Варфоломеева, д.92а

Oleg V. Polismak , Cand. Sci. (Med.), Center for Physical and Rehabilitation Medicine, physical and rehabilitation medicine physician, osteopathic physician

bld. 92A ul. Varfolomeeva, Rostov-on-Don, 344011

Приволжский исследовательский медицинский университет; Институт остеопатии; Северо-Западный государственный медицинский университет им. И. И. МечниковаРоссияPrivolzhskiy Research Medical University; Institute of Osteopathy; I. I. Mechnikov North-Western State Medical UniversityRussian FederationСеверо-Западный государственный медицинский университет им. И. И. МечниковаРоссияI.I. Mechnikov North-Western State Medical UniversityRussian FederationКлиническая больница «РЖД-Медицина»РоссияClinical Hospital «RZhD-Medicine»Russian Federation20261909202603180209Copyright © Потехина Ю.П., Яковлев Д.К., Полисмак О.В., 20262026Потехина Ю.П., Яковлев Д.К., Полисмак О.В.Potekhina Y.P., Yakovlev D.K., Polismak O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rojournal.elpub.ru/jour/article/view/836

Цель исследования — по данным современной научной литературы систематизировать результаты различных немедикаментозных методов для улучшения состояния равновесия и снижения риска падений.Материалы и методы. Был проведен поэтапный поиск научной литературы с использованием основных международных и отечественных баз данных: PubMed, Cochrane Library, PEDro, ScienceDirect, Web of Science, Google Scholar, eLibrary, КиберЛенинка, а также профильных научных журналов. Публикации выбирали в диапазоне 2019–2025 гг., однако в отдельных случаях учитывались и более ранние ключевые исследования, имевшие значимую методологическую ценность (большие рандомизированные клинические исследования, систематические обзоры и метаанализы). В финальный анализ было включено 53 исследования, удовлетворяющих всем критериям включения и невключения (сравнительные исследования и рандомизированные клинические исследования, наличие объективных количественных показателей). Результаты многочисленных методов немедикаментозного воздействия (мануальные методы, виртуальная реальность, тренировки с визуальной биологической обратной связью, восточно-ориентированные практики, баланстренинги и другие упражнения) у различных групп пациентов с постуральными нарушениями (пожилые с риском падений, болезнь Паркинсона, состояние после инсульта, заболевания опорно-двигательного аппарата и другие) собраны в тематические блоки.Результаты. Анализ результатов различных методов лечения позволил выделить общие закономерности, соответствие между характером воздействия и типом получаемого эффекта. Активные сенсорно-моторные вмешательства, особенно с использованием современных технологий (виртуальная реальность, стабилоплатформы с биологической обратной связью) или мануальных методов, обеспечивают наиболее выраженное улучшение функционального баланса и стабильности (высокие показатели по клиническим шкалам и стабилометрии). Комплексные многоцелевые программы также показывают высокую эффективность сразу по нескольким параметрам. Специализированные постуральные методы (core-stability) адресно улучшают показатели осанки и могут служить ценным дополнением, комбинируясь с баланс-терапией для полноты эффекта. Коррекция осанки (например, уменьшение смещения головы вперед) тесно связана с улучшением функционального равновесия, поэтому комбинирование методов, улучшающих биомеханику позвоночника, с баланс-тренингом представляется наиболее обоснованным. С другой стороны, восточные гимнастики и узконаправленные упражнения на равновесие дают более скромные результаты за короткий период. Они либо требуют более длительного времени, либо эффективны лишь в сочетании с другими средствами и более пригодны для профилактики постуральных нарушений без ограничения возраста. В целом наибольший клинический эффект достигается при использовании высокоинтенсивных или интегрированных подходов, тогда как низкоинтенсивные и изолированные техники уступают им по величине и скорости влияния на постуральный баланс.Заключение. Таким образом, одними из основных методов лечения и реабилитации пациентов с постуральными нарушениями являются разнообразные тренировки. Для получения клинически значимых результатов курс регулярных занятий должен длиться не менее 4 нед. Только в этом случае начинают укрепляться мышцы, увеличиваться подвижность суставов и позвоночника, восстанавливаться и формироваться новые нейрональные связи в ЦНС. Совсем необязательно делать сложные комплексы. Даже простые программы тренировок, которые человек может продолжать делать дома, при регулярном выполнении улучшают постуральный баланс и уменьшают вероятность падений. Кроме того, они могут быть рекомендованы для профилактики постуральных нарушений для разных групп населения. Чем более комплексное воздействие оказывается на систему постурального баланса (мультисенсорная стимуляция, укрепление мышечного корсета, коррекция осанки), тем значительнее и разностороннее улучшаются итоговые показатели пациента. И еще одна закономерность: большее общее время для лечения и реабилитации соответствовало лучшим результатам.

The aim of the study: to systematize the results of various non-drug methods in relation to improving balance indicators and reducing the risk of falls based on modern literature data.Materials and methods. A phased search of the scientific literature was conducted using key international and domestic databases: PubMed, Cochrane Library, PEDro, ScienceDirect, Web of Science, Google Scholar, eLibrary, CyberLeninka, as well as specialized scientific journals. Publications were selected between 2019 and 2025, but in some cases, earlier key studies with significant methodological value (large randomized clinical trials (RCTs), systematic reviews, and meta-analyses) were also considered. The final analysis included 53 studies that met all inclusion and exclusion criteria (comparative studies and RCTs, presence of objective quantitative indicators). The results of numerous non-drug methods of intervention (manual methods, virtual reality, training with visual biofeedback (BFB), Eastern-oriented practices, balance training and other exercises) in various groups of patients with postural disorders (the elderly at risk of falls, Parkinson′s disease, post-stroke conditions, diseases of the musculoskeletal system, etc.) are collected in thematic blocks.Results. An analysis of the results of various treatment methods revealed common patterns and a correlation between the nature of the intervention and the type of effect achieved. Active sensorimotor interventions, particularly those using modern technologies (virtual reality, biofeedback stabilization platforms) or manual methods, provide the most significant improvement in functional balance and stability (high scores on clinical scales and stabilometry). Comprehensive multi-target programs also demonstrate high effectiveness across multiple parameters. Specialized postural techniques (core stability) specifically improve posture and can serve as a valuable complement when combined with balance therapy for a more complete effect. Postural correction (e. g., reducing forward head posture) is closely linked to improved functional balance, so combining methods that improve spinal biomechanics with balance training appears most appropriate. On the other hand, oriental gymnastics and specialized balance exercises produce more modest results over a short period. They either require longer periods of time or are effective only when combined with other methods, and are more suitable for the prevention of postural disorders across all age groups. In general, the greatest clinical effect is achieved with high-intensity or integrated approaches, while low-intensity and isolated techniques are inferior in terms of the magnitude and speed of their impact on postural balance.Conclusion. Thus, one of the main methods of treatment and rehabilitation for patients with postural disorders is a variety of exercise programs. To achieve clinically significant results, a course of regular training should last at least four weeks. Only then do muscles begin to strengthen, joint and spinal mobility increase, and neural connections in the central nervous system recover and form. Complex programs are not necessary. Even simple exercise programs that a person can continue to do at home, when performed regularly, improve postural balance and reduce the likelihood of falls. Furthermore, they can be recommended for the prevention of postural disorders in various population groups. The more comprehensive the intervention on the postural balance system (multisensory stimulation, strengthening of the muscular corset, posture correction), the more significant and comprehensive the improvement in the patient′s overall performance. Another finding: longer total treatment and rehabilitation time corresponded to better results.

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The authors declare that there are no conflicts of interest present.