Introduction. Hemispasm is a severe neurological disease from the group of extrapyramidal disorders. This pathology, in addition to physical inconvenience, forms a person’s pronounced social problems due to cosmetic defects, significantly reduces the life quality, and increases the anxiety and depression level. The existing methods of therapy, both conservative and operative, do not always lead to the achievement of the set goal. This dictates the need searching for new treatment (including non-drug) methods with further introduction of it into clinical practice, and the development of new protocols for complex treatment of this patients group.

The goal of research — to research the clinical effectiveness of the osteopathic correction methods in the complex therapy of patients with hemispasm.

Materials and methods. From January to December 2019, a prospective controlled randomized study was conducted at the day‘ hospital of the Central City Clinical Hospital № 23 in Yekaterinburg. The study included 48 patients with facial hemispasm. 8 people left the study in accordance with the exclusion criteria. The remaining patients were divided by a simple randomization method using a random number generator into two equal groups of 20 people: the main and the control. The main group received standard drug therapy and additional osteopathic correction. In total, each patient underwent 4 sessions of osteopathic correction of 45 minutes each with an interval of 7 to 10 days. Patients in the control group received only standard drug therapy. All patients were examined by an osteopathic physician before and after the completion of treatment with an assessment of their osteopathic state. Also, all respondents were assessed for the degree of the palpebral fissure opening on the affected side, the anxiety and depression level, and the severity of the pain syndrome.

Results. Analysis of the dynamics of somatic dysfunctions (SD) average number, as well as the SD detection frequency at the global, regional and local levels in patients with hemispasm during treatment showed that the SD number and detection frequency statistically significantly decreased (p<0,05) in the main group patients in comparison with the control group as a result of the osteopathic correction inclusion in the complex therapy of patients with this nosology. In patients with hemispasm receiving osteopathic correction, there was a significantly more significant decrease of the pain syndrome severity and the anxiety and depression level (p<0,05). In terms of the palpebral fissure narrowing degree, there were no statistically significant differences between the groups after the treatment.

Conclusion. The obtained results allow us to recommend the inclusion of personalized osteopathic correction in the complex therapy of patients with facial hemispasm in order to increase the treatment effectiveness.

Introduction. According to Russian and foreign studies, the frequency of perinatal central nervous system (CNS) lesions continues to grow. The highest percentage of perinatal pathology and more significant deviations in subsequent development are observed among premature babies. An actual task is to expand non-drug methods of medical rehabilitation.

The goal of research — was to study the effectiveness of osteopathic correction of somatic dysfunctions in children with diagnosed perinatal CNS damage.

Materials and methods. In the period from 2015 to 2019 a prospective controlled randomized study was performed on the basis of ANO TIMM. The work is based on the results of observation and treatment of 125 children aged from 6 to 12 months with a diagnosis of perinatal CNS damage. Depending on the gestational age, all patients were divided into two comparable groups: main group (ex-term) and comparison group (ex-preterm) of 90 and 35 people, respectively. Patients of both groups received osteopathic care provided in accordance with the developed algorithm. All patients, before the start of treatment, during the course of therapy and at its completion, underwent osteopathic diagnostics in accordance with the approved clinical guidelines, as well as an assessment of neuropsychic development (NPD) and neurological status.

Results. The study showed that children of the first year of life with perinatal CNS lesions, regardless of gestational age at the time of birth, are characterized by the presence of somatic dysfunctions of all three levels — global, regional and local, with a dominating global somatic dysfunction. Dysfunctions of the head and neck region, diaphragm, and local somatic dysfunctions of the cranial sutures were most often observed. During treatment, patients of both groups showed a statistically significant decrease in the frequency of regional somatic head and neck dysfunctions and local somatic dysfunctions of the cranial sutures (p<0,05).

Conclusion. Osteopathic correction of somatic dysfunctions in children of the first life year with perinatal CNS damage, while following a certain sequence of methods for eliminating connective tissue disorders, including obligate decompression and elimination of edema and hypoxia, makes it possible to achieve a statistically significant (p<0,05) decrease in the clinical manifestations of perinatal CNS damage, and positive dynamics of NPD indicators, regardless of the gestational age at the time of birth.

Post-stroke periarthropathy of the shoulder joint (PPSJ) is one of the key assessment indicators of the poststroke patients management. Shoulder pain is a common complication of stroke, especially in patients with hemiplegia or severe hemiparesis. According to various authors, 16 % to 80 % of post-stroke patients have PPSJ. In 32 % of patients with post-stroke moderately severely impairments, the problem of shoulder pain persists for many years after the stroke. Due to the presence of pain in the shoulder joint, the range of motion in the affected joint is limited, so the patient does not try to correct this situation. As a result of it the joint contracture is formed and the quality of life of the patients after a stroke worsens. Thus, the problem of shoulder pain in patients after stroke has a high medical and social significance. For adequate rehabilitation of patients with PPSJ, it is necessary to understand well the pathogenesis of the problem in order to select a course of treatment for these patients. The purpose of this work is to systematize the available literature data and to present the etiopathogenesis of PPSJ from the perspective of somatic dysfunctions formation. The analysis of the available in the literature data about the PPSJ formation mechanisms and the main manifestations of this pathology allowed us to approach the consideration of etiopathogenesis from the perspective of dividing of all developing disorders into biomechanical, hydrodynamic/rhythmogenic and neurodynamic components being characteristic for somatic dysfunctions. The representation of the PPSJ etiopathogenesis from the perspective of the somatic dysfunctions formation provides a direction for further search for evidence for substantiating of the osteopathic correction effectiveness in patients with this pathology type.

Introduction. Piriformis syndrome (PFS) refers to tension of the piriformis muscle followed by compression of the sciatic nerve in the sciatic foramen. PFS occurs in 6-35 % of patients with low back pain. Such a dispersion can be explained by the difficulty in PFS diagnosing and its frequent non-detection against the background of concomitant masking pathologies. Despite the great progress in PFS research, much remains unclear. This concerns first of all the clarification of epidemiological data, risk factors and optimal treatment regimens. The widely used drug therapy does not always lead to the achievement of the required results, and it dictates the need searching for new therapy methods. Manual therapy has been successfully used for a long time in the treatment of patients with this nosology, however, most often, as an addition to the ongoing pharmacotherapy. Evaluation of the effectiveness and objectification of the manual treatment methods using as monotherapy has been little studied.

The goal of research — to study the clinical effectiveness of the manual therapy and pharmacotherapy in the treatment and rehabilitation of patients with piriformis syndrome.

Materials and methods. The study was conducted in 2018-2019 on the clinical basis of the Department of Sports Medicine and Medical Rehabilitation of the Federal State Autonomous Educational Institution of Higher Education I. M. First Moscow State University Sechenov (Sechenov University). The study involved 40 patients. All participants were divided into two equal groups. In the main group (group I), patients were treated with manual therapy methods, in the other group (group II), only pharmacotherapy was used.

Results. The use of manual therapy in patients with piriformis syndrome leads to a significantly more pronounced decrease in the degree of pain syndrome and normalization of impaired muscle tone, in comparison with pharmacotherapy. Complications and negative reactions during treatment and after the application of methods of manual influence were not observed in all cases.

Conclusion. There was a positive trend in the use of manual therapy methods for the treatment and rehabilitation of patients with piriformis syndrome in this study. It allows recommending the use of manual methods of treatment in patients with this nosology.

Introduction. Pain in the lumbosacral region is one of the most common causes of disability and seeking medical help. The most pronounced clinical manifestations and a protracted course of pain syndrome are observed in patients with discoradical conflicts. The anatomical and functional features of the segment of the lumbosacral region predispose to persistent compression of the S_I root, which makes it difficult to carry out analgesic therapy, leading the patient to long-term disability or to surgical intervention. Discogenic lesion of the SI root changes the biomechanics of not only the pelvic region and lower limb, but also affects the biomechanics of the whole body. Despite the success in the development of modern approaches to the treatment of this disease, the problem of increasing the effectiveness of treatment of patients with herniated discs of the lumbosacral spine remains relevant. One of the promising directions is the inclusion of methods of osteopathic correction in the complex treatment.

The goal of research — is to substantiate the inclusion of osteopathic correction in the standard therapy of patients with discogenic S_I radiculopathy.

Materials and methods. The study involved 30 patients with discogenic S_I radiculopathy. The two groups were formed by the method of simple randomization: the control group (15 people), whose participants underwent standard conservative treatment, and the experimental group (15 people), whose participants additionally underwent osteopathic correction. At the beginning and at the end of the study, all participants underwent a clinical and neurological examination (including an assessment of the motor function of the muscles innervated by the S_I spinal nerve, an assessment of sensitivity in the zone innervated by the SI spinal nerve, and an assessment of the Achilles reflex), an assessment of the intensity of pain syndrome using a visual analogue scale (VAS), anassessment of life quality by Oswestry Disability Index, and an assessment of osteopathic status. The obtained data were processed by methods of nonparametric statistics.

Results. It was found that the inclusion of osteopathic correction in the standard treatment of patients with discogenic S_I radiculopathy is accompanied by a more pronounced decrease in the number of regional somatic dysfunctions (SD), local SD of the musculoskeletal system and local visceral dysfunctions (the differences are statistically significant, p<0,05). The elimination of regional viscero-somatic and somato-visceral disorders of the L I-L V spinal cord segments, as well as local disorders of the ankle joint, coccyx and muscle-fascial formations of the pelvis, thigh, lower leg and foot is observed. In addition, there is a more pronounced decrease in the intensity of sensitivity disorders in patients and in the intensity of pain.

Conclusion. The obtained results allows to conclude that the inclusion of osteopathic correction in the standard conservative therapy of patients with discogenic S_I radiculopathy contributes to an increase of the treatment effectiveness.

Introduction. For modern people stress is an inevitable part of their life. Unfortunately, it is often assumed that stress is just a transient nervous tension that does not require treatment. This delusion only exacerbates the situation: one stressful situation is replaced by another, and the state of health is constantly deteriorating, and the psychosomatic disorders develop that have various clinical manifestations. Stress also aggravates the course of an existing pathology, and the presence of pathology is in itself a powerful stress factor. It should also be noted that stress is often accompanied by somatic dysfunctions for which osteopathic correction is effective. It is also impossible to imagine a modern person without dorsopathies, often associated with a sedentary lifestyle. Today, approximately 45 % of dorsopathies are in the cervical spine, of which 41.3 % of patients have cervicocranialgia. This pathology is characterized by frequent recurrence and progression, especially in people of the most working age, and it causes a high medical and social significance of cervicocranialgia. Frequent anomalies of the craniocervical zone, extensive fascial, visceral and muscle connections at the regional and global level, participation in the membrane system of mutual tension of the dura mater and suture structures of the skull — all this necessitates an integrated approach to the treatment of patients with cervicocranialgia, including osteopathic correction. All of the above allowed us to suggest that osteopathic correction may influence stress levels in patients with cervicocranialgia.

The goal of research — to study the effect of osteopathic correction on the level of stress in patients with cervicocranialgia in a state of severe psychological stress.

Materials and methods. The study involved 24 patients suffering from cervicocranialgia, characterized by prolonged exposure to severe psychological stress and high levels of cortisol in the blood. The study participants were divided into a control (12 people) and an experimental (12 people) group by the method of simple randomization using a random number generator. Participants in both groups received standard drug treatment for cervicocranialgia: non-steroidal anti-inflammatory drugs, B vitamins, muscle relaxants, angioprotectors and microcirculation correctors. The participants in the experimental group additionally received osteopathic correction. In both groups, before and after the course of treatment, the patients’ osteopathic status was assessed, the stress level was assessed using the PSM-25 psychological stress scale, and the morning blood cortisol level was measured. The obtained results were processed by methods of parametric and nonparametric statistics.

Results. It was found that both the standard drug treatment of patients suffering from cervicocranialgia and the complex treatment with the use of osteopathic correction contribute to a statistically significant decrease in the level of cortisol in the blood (p<0,0001 in the experimental group, p=0,001 in the control group). But only complex treatment, including osteopathic correction, was accompanied by a significant decrease in the level of psychological stress (p=0,001) and the number of regional somatic dysfunctions (p<0,005) in the participants of the experimental group. In the patients of the experimental group, the improvement in all indicators was statistically significantly more pronounced (p <0,01) than in the participants of the control group.

Conclusion. The obtained results demonstrate that the addition of osteopathic correction to the drug therapy of the patients with cervicocranialgia in a state of severe psychological stress gives a pronounced effect of the stress level reducing.

Introduction. Intraventricular hemorrhage (IVH) is a common neurological pathology in newborns (primarily premature babies) and remains a serious problem. The etiology of IVH seems to be multifactorial, the leading causes are fetal immaturity at the time of delivery, instability of the circulatory system and hemostasis.

The goal of research — to evaluate osteopathic status in preterm infants with intraventricular hemorrhage (IVH) depending on the severity of IVH.

Materials and methods. The study included 66 premature infants aged less than 18 days. Main group included 36 infants with IVH, control group — 30 infants without IVH. All newborns underwent general and neurologic evaluation, osteopathic evaluation and neurosonography.

Results. Osteopathic evaluation in preterm infants with grade 2 IVH revealed high prevalence of global rhythmogenic cranial somatic dysfunction (SD), in grade 1 IVH — global rhythmogenic cranial SD and regional SD of head region, in preterm infants without IVH — regional SD of dura mater region. In infants with IVH there was a significantly increased prevalence of global SD, whereas in infants without IVH regional SD was more prevalent (p<0,05). Global rhythmogenic cranial SD is significantly more prevalent in infants with IVH, compared to infants without IVH (p<0,05). This type of SD was more prevalent in IVH of higher grades. Regional SD of dura mater region in infants with IVH was less prevalent than in infants without IVH (p<0,05). Local SD are significantly more prevalent in infants without IVH compared to infants with IVH (p<0,05).

Conclusion. Osteopathic evaluation is recommended for preterm infants both with and without IVH for early diagnostics and correction of SD. Neonatologists and pediatricians could consider osteopathic consultation in preterm infants with IVH at abilitation and rehabilitation stage of treatment.

Introduction. Psychosomatic disorders (PSR) develop as a result of somatization of psychogenic factors. In osteopathy, PSRs are reflected in the so-called psychoviscerosomatic disorder which is a variant of a global neurodynamic functional disorder characterized by poly-regional disorders of tissue mobility that are associated with psychoemotional overloads. In most cases of PSR, neurotization of patients is obligate due to the involvement of a number of nervous structures in the pathological process and the subsequent general decrease in the body's adaptive reserves. According to the polyvagal theory of S. Porges (1995), the vagus nerve is divided into two functionally different branches: nucl. dorsalis n. vagi and n. ambigius. Third core nucl. tractussolitarii is the endpoint of many afferent pathways through n. vagus from peripheral organs, which forms the central regulator of the vagal system. In the process of phylogenesis, the vagus nerve system became more complex due to the inclusion of the pathways of the trigeminal, facial, accessory and glossopharyngeal nerves. S. Porges distinguishes the autonomic vagus nerve associated with passive regulation of visceral functions and the social or intellectual vagus, which is responsible for the processes of attention, movement and communication. The auditory sensory system provides encoding and evaluation of acoustic stimuli that determine the ability to adapt. We suggested that by affecting the auditory system, it is possible to affect the autonomic nervous system and reduce the severity of individual symptoms of PSR.

The goal of research — is to study the effect of white noise (WN) stimulation of the auditory sensory system on the manifestations of the disease in patients with cervicalgia (CA).

Materials and methods. In the period from 03.2020 to 07.2020 on the basis of the «Professor Novikov'sFamily Osteopathy Clinics», an analytical one-stage (cross-sectional) study was conducted, which involved 109 patients with an established clinical diagnosis of CA, who were divided into two groups: an experimental group (76 people) exposed to WN, and a control group (33 people), in which there was no such exposure. To irritate the auditory sensory system, a WN with a frequency of 1-22,05 kHz was used. Patients of the experimental group were divided into 3 groups depending on the level of neuroticism: low (13 people), medium (49 people), high (14 people). The examination included an assessment of the level of neuroticism, biomechanical indicators that characterize the volume of movements in the cervical region, and the level of pain. The L. I. Wasserman questionnaire was used to assess the level of personal neuroticism. The volume of movements in the cervical spine in degrees was determined using an original device for determining the mobility of the cervical spine. Subjective assessment of pain was performed using the VAS scale. To obtain a quantitative assessment of the achieved result, a «B-A-analysis» method is proposed, based on the evaluation of the modules of 6-timer (by the number of analyzed indicators) vectors A (after the study) and B (before the study) and pairwise analysis of the corresponding components of these vectors.

Results. Patients of the main group in subgroups with high, medium and low levels of neuroticism irritation auditory system has led to increased range of motion in the cervical spine that best identified patients with low levels of neuroticism, and minimally high. No significant changes were registered in the control group. There was no convincing difference in the dynamics of VAS indicators.

Conclusion. The study showed the possibility of influencing biomechanical parameters when the auditory sensory system is irritated by WN in patients with CA, and the result differed depending on the level of neuroticism — high, medium, low. The subjective assessment of the pain syndrome in VAS case is significantly influenced by the emotional component. Thus, if the nervous system is exposed, the biomechanical parameters changes take place, and it indirectly confirms the integrity and interdependence of the neurodynamic and biomechanical components of functional disorders. The results suggest further study of the possibilities of using WN in patients with various somatic dysfunctions accompanying PSR.

A case from clinical practice showing the positive results of the osteopathic correction use in the complex therapy of a patient with primary biliary cholangitis is described. The problem of primary biliary cholangitis (PBC, formerly known as primary biliary cirrhosis) attracts a lot of attention due to the uncertainty of the pathogenesis of this disease and the lack of methods of sufficiently effective therapy. The need for a complex approach to the therapy at the present stage, including using of non-drug treatment methods, is dictated by the desire to improve the life quality of this group of patients and delay liver transplantation. The lack of the literature data about the osteopathy effectiveness in the treatment of the pathology makes this message very valuable and opens up prospects for further study of the problem.

The relevance of research in the field of organization and provision of medical care to patients with the temporomandibular joint pain dysfunction syndrome (TMJ PDS) is determined by the prevalence of this disease not only among the pathologies of the maxillofacial region, but also among the pathologies of other organs and systems in general. Patients with the pathology of this joint are treated by doctors of various specialties. Therefore, there is often inconsistency not only in diagnostic algorithms, comprehensive examination and organization of medical care, but also in the terminological aspects of the TMJ PDS. The purpose of this review is to systematize the existing methods of diagnostics and treatment of TMJ PDS and to formulate possible options of osteopathic correction inclusion in the complex treatment of patients with this pathology. The review of literature sources on the problem of diagnosis and organization of treatment of TMJ PDS and masticatory muscle dysfunctions showed, on the one hand, a scientifically grounded spectrum of diagnostic and therapeutic capabilities of modern medicine, a trend in the development of highly informative digital technologies for diagnostic purposes, the development of various diagnostic and treatment protocols, a desire for an integrated approach involving specialists of different profiles. On the other hand, there is disunity between doctors of different specialties and the absence of a single algorithm for the diagnosis and treatment of TMJ PDS. Due to the variety of etiopathogenetic mechanisms of this disease development, further in-depth study of this issue is promising.

Dorsopathy and associated pain syndromes are among the most common worldwide diseases of the musculoskeletal system and connective tissue, and one of the leading causes of health loss. The characteristic signs of these conditions are the high prevalence (at the level of a pandemic), often - resistance to treatment, as well as persistent disablement incapacity, often leading to patient disability. Back pain is also a costly health problem. All of the above makes the work on the search for new methods and schemes for the treatment of dorsopathies relevant and in demand. The purpose of this article was to summarize modern ideas about the etiology and pathogenesis of dorsopathies, as well as to analyze the possibilities of reflexology using in the treatment of this nosology.

The goal of research in vivo study was to compare the effects on range of motion, neutral zone, stiffness and hysteresis of muscle energy technique (Mitchell) and an original approach of myotensive technique by strain shortening.

Methods. 23 healthy volunteers aged 22±2 years old were recruited, without any pain of the cervical spine. Each subject has received a myotensive technique (MET or SS) on the restricted side. The ranges of motion and torque were measured before and after the osteopathic technique. The neutral zones, stiffness and hysteresis were determined and compared.

Results. The MET showed significant differences on the range of motion, neutral zone stiffness, terminal zone stiffness and hysteresis. The SS technique showed significant differences in the neutral zone and the hysteresis. Conclusion. Our study suggests that the strain shortening technique has a positive effect on the viscoelastic properties of the tissues in cervical spine region.