Rationale for the use of osteopathic correction in the complex rehabilitation of chronic nonspecific low back pain in patients with postoperative scars on the anterior abdominal wall

Introduction. Low back pain (LBP) is one of the main causes of disability worldwide. The presence of postoperative scars on the anterior abdominal wall contributes to chronic nonspecific LBP and significantly affects the condition of the entire muscular-fascial system. As a result, the axial structures of the body also suffer. In this situation, standard diagnostic approaches are not informative, and pain treatment doesn′t bring desired results.

The aim of the study: In this article, we substantiate the use of osteopathic correction in the complex rehabilitation of chronic nonspecific LBP in patients with postoperative scars on the anterior abdominal wall.

Materials and methods. The prospective randomized controlled trial was conducted from February 2024 to October 2025 at the Medical Rehabilitation Department of the «RZhD-Medicine» Clinical Hospital (Bataysk Stat.). The participants were 80 women with scars on the anterior abdominal wall after a cesarean section: the study group consisted of 40 women, whose individual medical rehabilitation plan (IMRP) included two osteopathic corrections with an interval of 12–14 days; the control group consisted of 40 women, who received medical rehabilitation without osteopathic treatment. Research methods included osteopathic examination of patients according to clinical guidelines, measuring the distance from the tip of the third finger to the floor with forward and lateral bends, and visual analogue pain scale (VAS).

Results. During the osteopathic examination of patients with chronic nonspecific LBP and postoperative scars on the anterior abdominal wall, regional somatic dysfunctions (SD) were detected in all patients; however, SD of the lumbar and pelvic regions dominated. The results of rehabilitation with osteopathic correction demonstrated, among other things, a statistically significant decrease in SD of the structural components in the neck region (p<0,001) and the thoracic region (p=0,03). Likewise, in the study group, there was a statistically significant decrease in the severity of SD in the lumbar region visceral component (p=0,013), the lumbar region structural component (p=0,036), and the pelvic region visceral component (p=0,002). In the control group, only the severity of SD of the lumbar region visceral component decreased (p=0,049). Prior to the treatment, both groups had the same level of severity of pain and active mobility in the lumbar region (p>0,05). In the study group, the severity of pain significantly decreased from the range of 1–7 points (Me=4) to 0–4 points (Me=2), p<0,001, and in the control group, an insignificant decrease in pain was noted (p<0,05). The mobility indicators in the lumbar region improved in patients of the study group: forward bend Me decreased from 12 to 10 cm (p<0,001), whereas lateral bend Me decreased from 47 to 45 cm on the right (p<0,001) and from 47 to 46 cm on the left (p<0,001). In the control group, however, the forward bend test indicator increased from 12 to 13,5 cm, which shows a decrease in mobility (p=0,034).

Conclusion. This study demonstrated the effectiveness of including osteopathic correction in the complex of rehabilitation measures for patients with chronic nonspecific low back pain and postoperative scars on the anterior abdominal wall, which is manifested in a decrease in the intensity of pain, improved mobility of the lumbar spine, and a decrease in the severity or complete recovery from regional somatic dysfunctions.

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