Introduction. Muscular torticollis (MT) is the most common lesion of the musculoskeletal system in children, ranking third in pediatric practice. There are references in the literature confi rming high effi cacy of manipulative therapy, but in Cochrane′s 2015 Annual Review, experts did not fi nd evidence of the effectiveness of the manipulations. We carried out research in order to determine the effectiveness of osteopathic manipulative correction (OMC) in children with muscular torticollis (MT) due to birth injury (code for ICD X: P 15.8).

Goal of research — to study the gradual effectiveness of OMC on the basis of clinical and instrumental studies and ultrasound examination of the relationship between the bone structures and the cervical muscles.

Materials and methods. 57 children aged 0–7 years with muscular torticollis due to birth injury were examined. All patients were randomly divided into 2 groups. Patients of the main group (32 children) received osteopathic treatment. Each child received from 3 to 5 sessions, depending on the severity of the birth injury and the duration of postural disorders. The time gap between the sessions was 2–3 weeks. Patients of the control group (25 children) received physiotherapy, massage and orthosis every day for 2 weeks. Along with the neurological examination the study of the effectiveness of treatment included assessment of the pain syndrome with the use of the behavioral numerical scale FLACC, and the assessment of the muscle tone with the help of the kinesthetic examination. Angle of rotation in the cervical spine was measured with the use of the goniometer. Moreover, all children underwent sonography of the cervical spine in order to determine the position of the tooth axis, with the calculation of the coeffi cient of asymmetry. The state of the musculus rectus capitis major (MRCM) and musculus sterno cleido mastoideus (MSCM) was also assessed.

Results. It was observed that after OMC the clinically signifi cant improvement started earlier in patients of the main group. This improvement manifested by complete elimination or signifi cant reduction of biomechanical and tone disorders in the neck. Pain syndrome, measured with the help of the FLACC scale, signifi cantly decreased both after treatment and in catamnesis after 6 months (p0,05). When intercomparing left and right muscles in the groups, signifi cant differences were revealed (p0,05).

Conclusion. The use of OMC (3 to 5 treatment sessions with the intervals of 2–3 weeks) in patients with MT is more effective than the treatment with the use of physiotherapy, massage and orthotics, which was received by patients every day for 2 weeks. This allows to recommend OMC for wider clinical use in this category of patients.

Introduction. Coccygodynia is a multidisciplinary disease which is diffi cult to treat. It seriously limits the ability to work and signifi cantly affects the quality of life of patients. The study of somatic dysfunctions in patients with coccygodynia and the analysis of the results of osteopathic treatment of such patients makes it possible to justify the necessity of osteopathic correction of coccygodynia.

Goal of the study — to determine the structure of the leading somatic dysfunctions in patients with coccygodynia and to study the effectiveness of osteopathic treatment of this pathology.

Materials and methods. The study involved 44 patients from 25 to 65 years old, randomly divided into two groups. The main group of 24 people (20 women and 4 men) received osteopathic treatment, in accordance with the identifi ed leading somatic dysfunctions. Patients of the control group (16 women and 4 men) were treated locally with soft manual techniques (the treatment area was limited by the pelvic region). In order to assess the results of the treatment, we examined the intensity of the pain syndrome and the psycho-emotional state of patients. The severity of the pain syndrome was assessed in accordance with the visual analogue scale (VAS). The psycho-emotional state (with physical and mental components) was assessed with the help of the SF-36 quality of life questionnaire.

Results. Somatic dysfunctions typical for patients with coccygodynia have been identifi ed. Osteopathic treatment has proven to be more effective in comparison with local manual therapy of coccygodynia both in early periods and in 3 months after the end of the treatment course.

Conclusion. Osteopathic treatment of post-traumatic coccygodynia is effective, and can be recommended for treatment of such patients.

Introduction. In recent times there has been is a signifi cant increase in the level of injuries. According to the national and foreign authors, every year up to 20 % of patients coming to the trauma center are patients with injuries of the ankle joint. Among the injuries of the soft tissue structures of the ankle joint, isolated injuries of the capsular ligamentous apparatus, merit the most attention. They present up to 70–75 % of all ankle joint traumas. Traumas of the soft tissue structures of the ankle region often have serious consequences, such as chronic instability of the ankle joint, formation of periarticular pathologic ossifi cation, chondral bodies. Osteopathic techniques can help to reach more complete restoration of the functions of the limbs in rehabilitation of patients with lower limb injuries.

Goal of the study — to justify the necessity of use of osteopathic methods in complex treatment of patients with injuries of the capsular ligamentous apparatus of the ankle joint.

Materials and methods. The results of treatment of 30 female patients aged from 50 to 60 years with acute partial injuries of the capsular ligamentous apparatus of the ankle joint of the I and II degrees were examined. All patients were divided into two equal groups regardless of gender, age, severity and nature of injury by random sampling: the main group (n=15), who received osteopathic correction against the background of standard treatment and the control group (n=15) who received standard treatment only. During the treatment the range of movements in the foot was assessed by the amplitude of fl exion, extension, pronation, and supination in all the patients, with the use of the goniometer. Additionally, the length of the ankle circumference was measured. The intensity of the pain syndrome was also assessed in points with the help of the visual analogue scale (VAS). Examination of patients was carried out in 1–2 days after the removal of the gypsum bandage and in 6 weeks after the removal of the gypsum bandage.

Results. After the treatment all the patients presented a decrease in the circumference of the ankle joint, an increase in the amplitude of fl exion, extension, pronation, and supination. At the same time, after the osteopathic correction, the volume of movements was signifi cantly higher than after the standard treatment. The study of the subjective perception of pain has allowed to establish almost complete recovery of comfortable movements in the ankle joint by the end of the treatment in patients who underwent osteopathic correction.

Conclusion. Methods of osteopathic correction in treatment of patients with partial injuries of the capsular ligamentous apparatus of the ankle joint allow to reach the restoration of joint functions in a larger volume than standard methods of treatment.

Introduction. Nowadays an acute cerebrovascular accident and its consequences have become an important public health issue. One of the most common and severe complications of the stroke is periarthropathy of the shoulder joint, known as «frozen shoulder». According to different sources of information, the frequency of occurrence of this pathology ranges from 40 to 80 %. By now, no single concept of treatment of post-stroke periarthropathy of the shoulder joint has been developed.

Goal of research — to study the effectiveness and safety of osteopathic correction in complex therapy of pain syndrome in post-stroke periarthropathy.

Materials and methods. Patients undergoing treatment in the hospitals were randomly divided into 3 groups. In the fi rst group, the osteopathic treatment was performed in addition to the basic treatment. А periarticular blockade was additionally used in the second group. In the third group, traditional basic treatment was performed. The severity of the pain syndrome was assessed with the help of the visual analogue scale (VAS). The ability of movement in the shoulder joint and daily activity was controlled by a simple shoulder test (SST). The complex state of the shoulder joint was assessed according to the Swanson scale, which included both the patient′s subjective assessment and the medical examination data.

Results. The data obtained in the course of the study indicated that the additional use of medical diagnostic blockades provided a signifi cantly more important reduction in the intensity of pain syndrome, in comparison with the control group. This is of particular importance for patients with severe pain syndrome. At the same time, in the fi rst group, additional osteopathic treatment contributed to a more rapid and pronounced restoration of the functions of the affected limb with less regression of the pain syndrome.

Conclusion. Thus, the additional use of therapeutic blockade and osteopathic techniques should be differentiated and determined by the clinical performance of post-stroke periarthropathy of the shoulder joint.

Introduction. Dysfunction of the temporo-mandibular joint is a frequent, complex, multifactorial disease that is traditionally treated by orthodontic methods, but not always with a positive result.

Goal of research — to assess the effect of osteopathic treatment combined with orthodontic treatment on the temporo-mandibular joint dysfunction and osteopathic status of patients with TMJ disfunction.

Materials and methods. The study included 40 patients with the temporo- mandibular joint dysfunction receiving orthodontic treatment (hard and soft splints, brace system, exercises). All patients were women without severe somatic pathology divided into 2 groups: treatment group and control group. The mean (±SD) age of participants was 27,5±5,3 and 29,2±5,7 years, respectively. In both groups, osteopathic, orthodontic status have been evaluated, patients completed a questionnaire on the status of the temporo-mandibular joint. In the main group, the described orthodontic methods of treatment were supplemented by osteopathic correction.

Results. The study showed a decrease in the number of somatic dysfunctions, objective symptoms and subjective sensations arising from dysfunction of the temporo-mandibular joint. The analysis showed a greater effi cacy of combined osteopathic and orthodontic treatment in comparison with exclusively orthodontic treatment.

Conclusion. The obtained results provide possibility of further research of the effectiveness of osteopathic correction in combination with orthodontic treatment of the temporomandibular joint dysfunction.

Introduction. Slow fl uctuations in the volume and pressure of liquids in the cranial cavity have been known for a long time and have been studied for more than 100 years. However, their quantitative indicators and their practical signifi cance remain unclear until now due to the diffi culties of research. Nevertheless, it was found that they were connected with the brain activity, which made it possible to use them as one of the physiological indicators in studying the problems of manned space fl ights. Goal of research — to study the possibility of using spectral analysis of slow fl uctuations of the volume of liquids inside the cranium in order to realize the quantitative assessment of their indicators with the use of modern microelectronics and computer technology.

Materials and methods. In order to solve this problem we created a complex, in which rheoencephalograph-RG-01 («Mizar») was used as a converter-modulator of physiological signals into electrical oscillations. The device was connected with the ADC (Firm «ADIstrument»), Its software allows to calculate the spectrogram with a sampling rate of 128 kHz. Studies were conducted on volunteers of younger, middle and older age groups. The respiratory rate and the electrocardiography were registered together with the rheoencephalography. Electrodes were fi xed on the volonteers′ fronto-mastoid area.

Results. Slow fl uctuations the cranium representan independent physiological phenomenon. The most considerable and valuable were fl uctuations in 0,1–0,3 Hz. It was found that current frequency of 100 or 200 kHz and frequency for quantization of 80–100 kHz was optimal for performing their spectrograms. The structure of such diagram consists of 4–7 peaks with amplitude of 0,4–0,7 units compared with REG pulse amplitude. They depend on age and are characterized by hemispheric asymmetry. Spectral diagrams of slow fl ucation inside cranium are representing inpendent physiological phenomenon. These fl uctuations are not connected by common origin, with heart activity and respiration. They are connected by nature with brain activity and PRM.

Conclusion. Can be an informative method for diagnostic and assessment of general status of osteopathic patients well as for the assessment of mechanisms of action of some osteopathic techniques.

Introduction. An osteopathic examination determines the rate, the amplitude and the strength of the main rhythms (cardiac, respiratory and cranial). However, there are relatively few studies in the available literature dedicated to the influence of osteopathic correction (OC) on the characteristics of these rhythms.

Goal of research — to study the influence of OC on the rate characteristics of various rhythms of the human body.

Materials and methods. 88 adult osteopathic patients aged from 18 to 81 years were examined, among them 30 men and 58 women. All patients received general osteopathic examination. The rate of the cranial rhythm (RCR), respiratory rate (RR) heart rate (HR), the mobility of the nervous processes (MNP) and the connective tissue mobility (CTM) were assessed before and after the OC session.

Results. Since age varied greatly in the examined group, a correlation analysis of age-related changes of the assessed rhythms was carried out. Only the CTM correlated with age (r=–0,28; p<0,05) in a statistically significant way. The rank dispersion analysis of Kruskal–Wallis also showed statistically significant difference in this indicator in different age groups (p=0,043). With the increase of years, the CTM decreases gradually. After the OC, the CTM, increased in a statistically significant way (p<0,0001). The RCR varied from 5 to 12 cycles/min in the examined group, which corresponded to the norm. After the OC, the RCR has increased in a statistically significant way (p<0,0001), the MNP has also increased (p<0,0001). The initial heart rate in the subjects varied from 56 to 94 beats/min, and in 15 % it exceeded the norm. After the OC the heart rate corresponded to the norm in all patients. The heart rate and the respiratory rate significantly decreased after the OC (р<0,0001).

Conclusion. The described biorhythm changes after the OC session may be indicative of the improvement of the nervous regulation, of the normalization of the autonomic balance, of the improvement of the biomechanical properties of body tissues and of the increase of their mobility. The assessed parameters can be measured quickly without any additional equipment and can be used in order to study the results of the OC.

Introduction. In the genesis of the formation of somatic dysfunction, the leading role belongs to the reactions of the organism in the whole and of the connective tissue in particular. The main connective tissue cells are fibroblasts, possessing the full basic properties of cells.

Goal of research — to examine changes in the functional activity of fibroblasts in the process of modelling of compression, hypercapnia and hypoxia.

Materials and methods. During the experiment (in vitro), simulation of compression, hypercapnia and hypoxia in human fibroblast culture was carried out.

Results. In response to simulated changes in environmental conditions, fibroblasts changed their local habitat (intercellular substance) by changing the balance of elastin and collagen, and adapted morphologically (by changing their shape). Compression and hypercapnia had the most damaging effect on the main cells of the connective tissue

Conclusion. Determining of the dependence of the reaction of fibroblasts on damaging effects can form the basis for justifying the sequence of the use of methods aimed to eliminate connective tissue disorders in the process of osteopathic correction (decompression, reduction of edema and hypoxia).

Introduction. In connection with the widespread introduction of osteopathy into practical medicine, new facts confi rming its effectiveness are appearing. These facts need theoretical justifi cation. The biodynamic approach is the least studied and scientifi cally proven approach in osteopathy. There are only a few works describing the benefi cial effects of this type of treatment on the autonomic nervous system based on an assessment of heart rate variability. One of the most sensitive indicators of changes in the state of the body is the electrical activity of the skin (EAS), which is widely used in modern polygraphic devices.

Goal of research — to investigate the EAS in the physician and in the patient during the session of craniosacral biodynamics (CSB).

Materials and methods. The study involved 32 patients who were randomly divided into 2 groups — control group (10 patients) and main group (22 patients). In the control group there were 8 women and 2 men aged from 20 to 65 years (mean age 42±20 years). In the main group, 16 women and 6 men aged from 18 to 68 years (mean age 40±16 years) were examined. Two professional certifi ed computerized polygraphs «Chris» were used, simultaneously recording the EAS values of the doctor and the patient. In the main group, the background indicators were recorded at the fi rst stage (10 minutes), then the procedure of the CSB, which lasted 20 minutes, was recordered. The control group was used only for registration of EAS. At the same time, patients were in the same conditions as in the main group.

Results. During the CSB, the state of both the doctor (p<0,001) and the patient (p<0,001) has changed signifi cantly. At the same time, the tendency of changes in individual indicators of EAS in patients during treatment was logical. The altered state of the physician practically did not depend on its original level (p>0,05). However, there was a high relationship between the states of the doctor during contact and non-contact treatment (correlation coeffi cient 0,80, p<0,001). The patient′s initial condition had a moderate, statistically signifi cant relationship with his condition during the treatment (p<0,001). Since the beginning of the craniosacral biodynamics, the patient′s condition has hardly changed. At the same time, the contactless impact on the patient′s body was comparable with the contact effect (correlation coeffi cient 0,97, p<0,001). There was no signifi cant relationship between the states of the physician and the patient before the beginning of the treatment (correlation coeffi cient 0,18, p>0,05). However, in the process of craniosacral biodynamics, a statistically signifi cant relationship was formed between them with a correlation coeffi cient for non-contact exposure equal to 0,49 (p<0,01) and for contact exposure — 0,34 (p<0,05). Biodynamic treatment statistically signifi cantly improved the state of the autonomic nervous system.

Conclusion. The study of the electrical activity of the skin in craniosacral biodynamics is a highly informative method, which allows to verify and quantify the changes occurring in the patient and in the physician during the treatment.

Introduction. To date there is a lack of studies dedicated to the objectification of the palpation data obtained by a specialist during the osteopathic examination. The issue of the evidence of the results of osteopathic correction still remains important. Search for instrumental methods allowing to register and to measure various palpation phenomena and manifestations of somatic dysfunctions is very relevant for the development of osteopathy as a science. It is also very important to find objective characteristics of these methods.

Goal of research — to study viscoelastic characteristics of the soft tissues of the lower legs by palpation and instrumental methods before and after osteopathic correction.

Materials and methods. 22 volunteers (12 women and 10 men) aged 18–23 years without complaints of the musculoskeletal system were examined. Osteopathic diagnostics and measurement of the viscoelastic properties of muscles were carried out by the method of vibration viscoelastometry before and after osteopathic correction.

Results. Correlation analysis by Spearman showed that the subjective assessment of an osteopath positively correlated with both elasticity (r=0,43, p<0,05) and viscosity of soft issues (r=0,29, p<0,05). For the gastrocnemius muscle, this pattern was even more pronounced — for elasticity r=0,51, p<0,05, for viscosity =0,34, p<0,05. After osteopathic correction no changes in the elasticity of the soft tissues were observed. The viscosity of the tissues reduced, but in the projection of the gastrocnemius muscle, these changes were not statistically significant (p=0,12), whereas in the projection of the soleus muscle statistically significant changes (p=0,034) were observed.

Conclusion. Changes in the viscoelastic properties of tissues demonstrated that the effects of osteopathic correction with the use of myofascial mobilization techniques, articulation mobilization techniques, and lymphatic drainage techniques were not obvious. The elasticity of soft tissues of the lower legs did not change, while the viscosity decreased, especially in the projection of the soleus muscles. This effect of the osteopathic correction can be associated with the effect of thixotropy — the transformation of gel-like intercellular substance into sol. Thus, the research showed that vibration viscoelastometry can be used for the objectifi cation of the condition of soft tissues and of the effects of osteopathic correction.

Introduction. Before the discovery of X-rays, the developmental anomalies of the musculoskeletal system were studied by anatomists. The X-ray method contributed to the signifi cant progress in the research and to the improvement of the diagnostics of developmental anomalies in vivo, including in the spine. Goal of research — to assess the frequency of anomalies and their types at all levels of the spine in patients suffering from dorsopathy.

Materials and methods. Roentgenograms of all spinal regions of 399 patients aged 29–49 (169 men and 230 women) who came to see manual therapists and osteopaths about dorsopathy were studied with the use of the system analysis method.

Results. The analysis showed that anomalies in the development of the spine occur in more than 80% of young and middle-aged patients who came to see an osteopath or a manual therapist, i. e. in 8 patients out of 10. Most patients (¹⁄³ of patients) had one developmental anomaly in the whole spine. Two developmental anomalies at different age periods occured on average in every fourth patient. Three spinal developmental anomalies were less common and were diagnosed in ¹⁄6 of patients. Four to six developmental anomalies throughout the spinal column were found in ¹⁄10 of middle-aged patients with dorsopathy. Cervical ribs, sacralization and the open channel of the sacrum were the most frequent anomalies. In patients with sacralization, symmetrical bilateral sacralization was as frequent as asymmetrical sacralization. An enlarged transverse process of L_V was found on the left 3 times more often than on the right in patients with asymmetrical sacralization.

Conclusion. Models of the system analysis of roengenograms of the spine are a reliable source of information for analyzing the frequency and localization of developmental anomalies at all levels of the spine.

Although joints with synovial cavities and articular surfaces are very variable, they all have one common peculiarity. In most cases, one of the articular surfaces is concave, whereas the other one is convex. During the formation of a joint, the epiphysis, which has less kinetic energy during the movements in the joint, forms a convex surface, whereas large kinetic energy forms the epiphysis with a concave surface. Basing on this concept, the analysis of the structure of the joints, allows to determine forces involved into their formation, and to identify the general patterns of the formation of the skeleton.

A clinical case, described in this study, demonstrates a successful combined treatment of posttraumatic neuropathy of the medial and radial nerves in a patient after the closed comminuted fracture of the distal metaepiphysis of the left radial bone with a fragment displacement. One of the most serious complications of such injuries is the development of carpal tunnel syndrome [1]. Osteopathic physicians were involved in the process of treatment and rehabilitation. According to the data of various authors [1, 2], it is necessary to use complex surgical aids such as decompression of the medial nerve by dissecting the carpal ligament with the scar, as well as nerve transposition if the conservative methods are not effective. Unfortunately, surgical treatment does not always lead to a positive result [4]. Invalidization of patients is significant — 5–7%. It is known that early complex pathogenetic treatment allows to fight against the developing carpal tunnel syndrome in patients with severe bone trauma much more successfully. In order to prevent scar changes of the carpal ligament and maintain adequate trophicity in the injured limb, it is necessary to implement measures aimed at stabilizing microcirculatory disorders in the distal parts of the injured forearm as soon as possible. In order to make the treatment of this pathology even more effective, an integrated approach to solving this complex and socially significant problem is needed, as well as the search for new advanced and relatively safe treatment tactics, these include osteopathic correction too.

The article provides an overview of concepts, ways and methods of formation of healthy lifestyle in patients, which is necessary for the osteopathic work. Authors give recommendations on the most relevant topics for patients seeking osteopathic treatment.

Les termes de tenségrité et de biotenségrité sont utilisés de plus en plus souvent dans les articles et dans les cours d′ostéopathie du monde entier; mais le plus souvent les commentaires qui les précèdent ou les accompagnent montrent que les principes et les concepts qu′ils recouvrent ne sont qu′effl eurés et, bien souvent, peu ou mal compris. Or, les principes des constructions en tenségrité s′appliquent de manière étonnamment adaptée à la compréhension de «comment», en ostéopathie, nous questionnons et réajustons le réseau fascial du corps humain et ce, quel que soit la technique utilisée. En effet le réseau fascial associe des éléments solides en discontinuité et des éléments souples qui créent la continuité et forment une globalité dont tous les éléments réagissent et se réorganisent sous la contrainte. La tension et la compression qui se déploient simultanément dans des directions opposées de la trame fasciale se répartissent depuis l′échelle macroscopique jusqu′à l′échelle microscopique des ensembles Ostéo Myo Fasciaux du corps ; une des conséquences importantes de cette réorganisation étant de préserver l′homéostasie. Ainsi, entrer en relation par le toucher avec le dynamisme tenso-compressionnel ainsi qu′avec l′aspect vibratoire des éléments du vivant selon les modélisations géométriques et les principes architecturaux proposés par la tenségrité, permettra une meilleure compréhension et un accompagnement très abouti de nos gestes ostéopathiques.

Evgueniya Shyryaeva: «My main teachers are my patients».

«Osteo Poly Clinic» Clinic of Osteopathy and Classical Medicine «Osteo Poly Clinic».