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Russian Osteopathic Journal

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No 1 (2021)
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ORIGINAL ARTICLES

8-19 775
Abstract

The formation and development of osteopathy as a scientific discipline is considered. Despite its one and a half century history, osteopathy is a relatively young medical specialty. At the same time, throughout the history of the existence of osteopathy, its supporters carried out an active search for scientific evidence of its effectiveness. Currently, osteopathy is going through the stage of scientification, its formation as a scientific discipline. However, even now even the term osteopathy itself is often interpreted quite loosely and, in some cases, tendentiously. In this regard, the purpose of this work is to trace the development of osteopathy — from the earliest works of its founders to the latest stage of development, when osteopathy has become more and more consistent with the basic requirements of evidence-based medicine. To achieve this goal, much attention is paid to all stages of the formation and development of osteopathy, both abroad and in Russia. There are considered such problems as the formation of the basic terminology, the development and change of the basic concepts of osteopathy, including the concept of osteopathic lesion and the concept of somatic dysfunctions, the development of modern methods of evidence-based medicine, the dynamics of publication activity of osteopathic researchers. It concludes that new ways of obtaining the data about the health effects of osteopathy will continue to emerge, and the level of evidence and the number of quality clinical trials are likely to change.

20-33 892
Abstract

Introduction. Back pain is not only a high prevalence, but also a costly health problem. That is why the search for new and the optimization of existing methods of dorsopathies treatment acquire an important clinical and medico-social significance. In recent years, the medical community has increased the interest in non-drug methods of treatment, including osteopathy. Previous studies have substantiated the possibility of effective application of osteopathic correction methods in the treatment of patients with dorsopathies. A specific object of the osteopath′s work is somatic dysfunction (SD). And if earlier SD was perceived from the standpoint of purely biomechanical disorders, then in recent years there have been serious changes in understanding the heterogeneity of this state nature. The biomechanical, rhythmogenic and neurodynamic components are conventionally distinguished in the structure of SD. One of the neurodynamic disorders types is the violation of motor stereotypes, the so-called static-dynamic disorders, revealed through special dynamic tests and manifested in the functional impossibility of building of active movement at various levels. At the same time, the generally accepted biomechanical approaches do not allow to completely eliminate violations of the statodynamic stereotype.
The goal of research — the study was to research the effectiveness of the osteopathic approach using in combination with kinesitherapy for correction of the statodynamic stereotype violations in patients with dorsopathy at the cervicothoracic level.
Materials and methods. A controlled randomized prospective study was conducted on the basis of a private rehabilitation center «Ezramed-Clinic» in Omsk in the period from February 2019 to December 2019. 52 patients with a diagnosis of dorsopathy at the cervicothoracic level were observed. 12 people were knocked out during the study in accordance with the exclusion criteria. As a result, 40 patients participated in the study. Depending on the applied treatment method, the patients were divided by simple randomization into two groups (main and control), each of which consisted of 20 people. Both groups of patients received osteopathic correction three times with a frequency of receptions 1 time in 7–10 days. The main group of patients additionally independently performed daily for 10 minutes a set of exercises aimed to restore the disturbed motor stereotypes (normal synkinesis). The control group of patients additionally independently performed a set of exercise therapy for the cervical spine every day for 10 minutes. All patients, regardless of the group, underwent an osteopathic examination before and after treatment with the formation of an osteopathic conclusion; the severity of pain syndrome and the volume of active movements in the cervical spine were assessed. The severity of the pain syndrome and the range of active movements were assessed before and immediately after treatment, as well as 3 months after the first session.
Results. The use of osteopathic correction in conjunction with kinesitherapy (both special exercises and a complex of exercise therapy) in patients with a diagnosis of dorsopathy at the cervicothoracic level leads to a statistically significant increase in the range of motion in the cervical spine in the sagittal and frontal planes (p<0,05). The combination of osteopathic correction together with exercise therapy in patients of the control group led to a statistically more significant increase (p<0,05) in the range of motion in the cervical spine in the frontal plane after treatment compared with the results of the main group. However, 3 months after treatment, the indicators in patients of both groups did not have statistically significant differences.The combination of osteopathic correction in conjunction with kinesiotherapy in the form of special exercises for the motor stereotype correction in the main group of patients with diagnosed dorsopathy at the cervicothoracic level led to a statistically significant (p<0,05) decrease in the intensity of the pain syndrome at the 2nd session.
Conclusion. In order to increase the effectiveness of treatment, osteopathic correction of somatic dysfunctions in patients with dorsopathy at the cervicothoracic level can be supplemented with complex kinesitherapy, both in the form of traditional exercise therapy, and in the form of special exercises for correction of altered motor stereotype.

34-44 1063
Abstract

Introduction. The health status of children of the first year of life is primarily affected by the course of pregnancy and childbirth, as well as hereditary factors. During the newborn period, reversible disorders may occur, which can be estimated as somatic dysfunction (SD). The formation of SD in young children has its own causes and features, which have not been studied in detail until now.
The goal of research — is to study the features of the osteopathic status in children of the first year of life with different patterns of pregnancy and delivery methods for their mothers.
Materials and methods. Since 2015, for 5 years, a prospective multicenter study has been conducted to investigate the osteopathic status of children of the first year of life under a single protocol in 6 cities of Russia, organized by the Institute of Osteopathy (St. Petersburg) and the Department of Osteopathy of Mechnikov North-West State Medical University. A total of 360 full-term infants aged 1 to 12 months with perinatal hypoxic-ischemic lesions of the central nervous system, and practically healthy ones were examined. All children underwent an osteopathic examination, and a detailed history of pregnancy and childbirth was collected. Based on the results of the obstetric history analysis the following groups were selected: physiological course of pregnancy, ending in physiological childbirth through the natural birth canal — 62 people; physiological course of pregnancy, ending with operative delivery — 25 people; physiological course of pregnancy, ending in complicated labor through the natural birth canal — 20 people; pregnancy with complications, ending in physiological childbirth through the natural birth canal — 104 people. Statistical processing of the obtained results was carried out by nonparametric methods using the Statistica 10.0 software.
Results. In children born by physiological childbirth with complicated pregnancy, a smaller number of local SD (p=0,04) and a larger number of global SD were detected, but the difference with the subgroup of the pregnancy physiological course did not reach the statistical significance. In children whose mothers had a physiological course of pregnancy, but childbirth proceeded with complications and required the use of obstetric assistance, the significantly more number of regional SD were revealed (p<0,0001) compared with children born in physiological childbirth. The latter had a greater number of local SD of the craniosacral system (p=0,035). In children born by caesarean section and in children born through the natural birth canal without complications, the number of global, regional and local SD did not differ statistically significantly. Osteopathic examination of children in the first year of life showed that the first three places in the structure of dominant SD were occupied by SD of the neck, head, and dura mater.
Conclusion. Based on the data obtained as a result of the study, it can be assumed the presence of numerous factors that can lead to the formation of various SD in children of the first year of life during pregnancy and especially during childbirth. It is necessary to further study the features of the osteopathic state in children in the postnatal period.

45-59 468
Abstract

Introduction. The problem of predicting and preventing of the complications development in the intra- and postoperative period is acutely relevant. There is strong evidence for a correlation between the patient’s preoperative status and the incidence of perioperative complications. At the same time, the search for additional methods for assessing and correcting the preoperative status remains an important task of modern medical science. In the context of this task, more and more attention is being paid to the approaches to diagnosis and treatment developed by osteopathy. Information about such studies for patients planned for abdominal surgery is practically absent in open sources today.
The goal of research — is to substantiate the possibility of osteopathic correction inclusion in the measures complex for the preoperative preparation of patients planned for extended abdominal surgery.
Materials and methods. The study involved 30 patients planned for extended abdominal surgery. The main and control groups were formed by the method of simple randomization, 15 people were included in each group. The participants of the control group received a standard set of measures for preoperative preparation, and the participants of the main group additionally underwent a course of osteopathic correction. The functioning indicators of the respiratory system [including the rapid shallow breathing index (RSBI) and the maximum value of the negative inspiratory force (NIF)] and the autonomic nervous system (Kerdo index), the pain syndrome severity (assessed by a visual analogue scale), and the actual time of transfer opportunity of patients from intensive care to a profile department (assessed by a modified Aldrete–Kroulik scale).
Results. It was found that after the premedication with the previous osteopathic correction course, the number of patients in a state of eutonia has significantly increased, and the number of patients with increased sympathetic tone has decreased. The patients who received osteopathic correction had a statistically significantly lower RSBI index and higher NIF values than those who did not receive the correction (p<0,05). The actual time of the patients transfer to a profile department was also statistically significantly shorter in patients who received osteopathic correction (p<0,05).
Conclusion. The obtained results make it possible to recommend the inclusion of osteopathic correction in the complex of measures for the preoperative preparation of patients planned for extended abdominal operations.

60-68 458
Abstract

Introduction. Pain in the lumbosacral region is one of the most common causes of disability and medical attention acquiring. Magnetic resonance imaging (MRI) of the spine in these patients quite often demonstrates multiple hernias. Despite the success of modern, including complex, methods of treating patients with herniated discs of lumbosacral spine, the problem of objective revealing of the applied therapy effect with modern instrumental examination methods is actual.
The goal of research — study was to study the changes in the MRI picture in patients with herniated intervertebral discs during treatment with inclusion of osteopathic correction.
Materials and methods. The study involved 15 patients with herniated intervertebral discs of lumbosacral spine. The patients received outpatient conservative treatment with inclusion of osteopathic correction. Participants underwent MRI of the lumbar spine at the beginning of the study and 3 months after treatment. The obtained data were processed by methods of nonparametric statistics.
Results. After the complex treatment, such indicators of MRI as the hernia size, the lateral pocket width and the pelvis configuration significantly improved. These parameters are important indicators of pathomorphological changes in the spinal motion segment, affecting the discoradicular conflict. At the same time, there were no obtained convincing data about the therapy effect on the L5 vertebra rotation, on the presence of sequestration and changes in the Tchaikovsky index. Perhaps this is due to the small sample and short follow-up period for patients.
Conclusion. After the course of treatment with inclusion of osteopathic correction, the statistically significant changes in MRI images were revealed in patients with herniated intervertebral discs, indicating a positive dynamics in the parameters of the hernia size, the width of the lateral pocket and the configuration of the pelvis.

69-79 2700
Abstract

Introduction. Gastroesophageal reflux disease (GERD) is now widespread throughout the world, with clear evidence of incidence increase in many countries. The importance of GERD is caused by the fact that it leads to a significant decrease in the patient′s life quality, the appearance of extraesophageal symptoms (chest pain, persistent cough) and the risk of such complications as bleeding from ulcers and erosions, the development of peptic strictures, and esophageal adenocarcinoma. After stopping the medicine treatment, the relapse quickly occurs and it is the main risk factor for the development of Barrett′s esophagus — a precancerous pathology of the esophagus. Therefore, the search for additional, non-drug methods of treatment for increasing the standard therapy effectiveness is in demand. Osteopathic correction of somatic dysfunction can be one of these methods. To date, there is some evidence of the osteopathic correction effectiveness in children with GERD.
The goal of research — to study the effectiveness of osteopathic correction in the complex treatment of adult patients with GERD.
Materials and methods. The study involved 20 people, divided by simple randomization into two equal groups: control and main. The control group received standard treatment, the main group received additional osteopathic correction. At the beginning and at the end of the study, there were assessed the osteopathic status of patients and the severity of the disease using the GerdQ questionnaire. The obtained data were processed by methods of nonparametric statistics.
Results. The inclusion of osteopathic correction in the complex treatment of patients with GERD is accompanied by a statistically significant decrease in the number of local and regional somatic dysfunctions (SD), a significant redistribution of the dominant SD structure, and a decrease in the severity of previously dominant SD in the neck and thoracic region. Compared with patients who did not receive osteopathic correction, there is a statistically significantly more pronounced decrease in the severity of GERD clinical symptoms.
Conclusion. Despite the relatively small number of patients who participated in the study, the obtained results make it possible to recommend the inclusion of osteopathic correction in the complex therapy of patients with GERD.

80-89 626
Abstract

Introduction. Many key questions regarding the etiology, pathogenesis, clinical manifestations and treatment of chronic gastritis remain open. So, despite the success of chronic gastritis pharmacotherapy, much attention is paid to non-drug methods of therapy, in particular, osteopathy. However, evidences of the osteopathic methods effectiveness for the chronic gastritis treatment, obtained by objective instrumental methods, are insufficiently presented in the modern literature.
The goal of research — to study the results of osteopathic correction inclusion in the complex therapy of patients with chronic gastritis.
Materials and methods. The study involved 50 patients with chronic gastritis, divided by simple randomization into a control group (25 people) and a main group (25 people). The participants in the control group received standard eradication therapy according to a three-component scheme. The participants of the main group additionally received osteopathic correction. In both groups, at the beginning and at the end of the study, there were performed fibroesophagogastroduodenoscopy with targeted biopsy to assess the gastric mucosa state, Helicobacter pylori identification, and intragastric pH-metry to assess gastric juice acidity.
Results. According to the study results, a statistically significant (p<0,05) decrease in edema and hyperemia of gastric mucosa was found in the control and main groups. There was a statistically significant (p<0,001) decrease in gastric aciditywith osteopathic accompaniment, compared with unaccompanied drug treatment. In both groups, there was a statistically significant (p<0,05) decrease in the incidence of Helicobacter pylori carriage.
Conclusion. Based on the obtained results, it can be assumed that an integrated approach using osteopathic correction in the treatment of chronic gastritis may be more effective than the standard course of treatment.

CASE REPORT

90-98 618
Abstract

Dorsopathy and associated pain syndromes are among the most common diseases of the musculoskeletal system and connective tissue. Despite the relatively high level of the problem knowledge, the dorsopathies treatment still remains a fairly serious task for clinicians. A combination of medication and non-medication treatment methods is optimal. Some studies have previously demonstrated the clinical efficacy of osteopathic correction methods using in the complex therapy of patients with dorsopathies. The issues of isolated application and mutual compatibility of various non-drug methods have not yet been studied enough. The article describes a case from practice devoted to the isolated use (monotherapy) of osteopathic correction in a patient with dorsopathy, and discusses the features of individual regional somatic dysfunctions identification and filling out an osteopathic conclusion.

LECTURES

99-108 520
Abstract

The article discusses the application of the International Classification of Functioning, Disabilities and Health (ICF) in the diagnostic practice of an osteopathic physician. The ICF is an internationally recognized classification of health constituents and health-related factors. ICF allows the osteopathic physician to formulate the goals of the patient′s treatment, to determine the terms of treatment. A clinical example reveals the possibilities of using ICF in osteopathy.

REVIEWS

109-124 2438
Abstract

Introduction. The incidence of myopia tends to grow steadily, and therefore, it can be characterized as a disease of the 21st century. Even with complex ophthalmological treatment, refractive indices do not improve, and only in 18 % of cases these indices are stabilized. The effect of osteopathic correction (OC) on visual acuity is insufficiently studied. A comprehensive review of the evidence on this issue may help estimate the use of OC in existing health care programs for myopia and accommodative spasm in children.
The goal of research — to study, according to the literature, the effect of osteopathic correction of somatic dysfunctions in children of different ages on the state of refraction in myopia, spasm of accommodation.
Materials and methods. The selection of scientific papers according to the following criteria. Inclusion criteria: children aged 5 to 18 years with a history of diagnosis: myopia of varying degrees, spasm of accommodation; the dividing patients into 2 groups: in the experimental group — osteopathic and ophthalmological treatment, in the control group — standard ophthalmological treatment; the results of an ophthalmological examination are described; the duration of observations is from 3 to 6 months. Exclusion criteria: description of a single clinical case; the diseases are not associated with disorders of the visual apparatus; the study sample is less than 30 patients. The Jamovi statistical analysis software was used to perform the meta-analysis. The Newcastle-Ottawa scale was used to assess the risk of bias in cohort studies.
Results. There were selected 3 scientific works studying the influence of osteopathic correction on the state of refraction in myopia, spasm of accommodation in children. On the Newcastle-Ottawa scale, all three studies had a total score of 8, indicating a low risk of bias. The odds ratio was 20.884, which is a high indicator revealing the effectiveness of the OC together with ophthalmological treatment of myopia, accommodation spasm in children of different ages. Thus, we can say that when similar studies will be repeated, the achievement of a positive effect when using OC as part of a complex treatment in 95 % of cases will be higher than the use of only ophthalmological treatment of children with myopia, accommodation spasm.
Conclusion. Based on the studied literature and the conducted meta-analysis, we can make a preliminary conclusion that the inclusion of osteopathic correction in the complex treatment can give an additional advantage over standard treatment in children with refractive disorders.

125-137 777
Abstract

The goal of the review is the systematization of the main factors influencing on the appearance of clinical signs of carpal syndrome of median nerve. In this lecture, an emphasis is placed on the problem of dynamic carpal tunnel syndrome, the symptoms of which are provoked by physical exertion and/or a certain position of the limb, due to compression and/or overstretching, as well as abnormality of longitudinal and transverse sliding of the median nerve. These symptoms subside with the termination of the action of the provoking factor and return when the movements are repeated. Neurological examinations and nerve conduction tests performed at resting state usually do not reveal changes. This lecture also discusses the features of clinical biomechanics and pathophysiology of the median nerve. For topical diagnosis of the level of nerve compression and in order to accurately understand whether there is an abnormality of the mobility of the nerve tissue, it is necessary to carry out manual testing of the muscles innervated by the median nerve, with the arm and neck of the patient being examined in a neutral position, and during provocative neurodynamic tests. According to clinical neurodynamics therapeutic measures should be directed to all interdependent components of the peripheral nervous system in the following sequence: osteopathic treatment of the nerve trunk interface (tissues surrounding the nerve trunk); osteopathic treatment of innervated tissue; osteopathic treatment of the connective tissue of the median nerve. During this sequence of treatment, we carry out manual correction of the functional blocks of the joints of the hand and the radiocarpal joint, inactivate trigger points in the muscles surrounding the median nerve (round pronator, flexors of the fingers of the hand, etc.), carry out fascial release directly to the nerve bed itself. Then we perform passive and active mobilization of the nerve trunk in the longitudinal and transverse directions. After the end of osteopathic treatment, it is necessary to prescribe special neurodynamics exercises to mobilize the median nerve.

OSTEOPATHY ABROAD

138-150 1823
Abstract

Introduction. Latent myofascial trigger points (LMTPs) are responsible for intense and spontaneous pain. Non-traumatic mechanical neck pain is characterized by the presence of pressure hyperalgesia in the cervical spine, which equally affects the cervical muscles, such as upper trapezius, since these muscles receive their innervation from the CII–IV levels.
The goal of research — to find out how the release technique by pressing on the LMTP of the upper trapezius immediately affects the pressure pain threshold (PPT) of this muscle, of the elevator muscle of scapula, the greater occipital nerve (GON), the supra-orbital nerve (V1) and articular processes of CIII–IV bilaterally, as well as on the range of active neck movements (RANM).
Materials and methods. Sixty subjects diagnosed with LMTP in the antero-superior fibers of the upper trapezius muscle were included in the study. PPT values were measured bilaterally in the upper trapezius, elevator muscle of scapula, GON, V1, and CIII–IV articular processes using a digital algometer. RANM in flexion, extension, homolateral lateral flexion, contralateral lateral flexion, homolateral rotation, and contralateral rotation were measured with a bubble inclinometer. The intervention group received the MTP release technique, and the control group received a placebo technique with ultrasound without intensity.
Results. The results obtained show that the release technique by pressing on the LMTP of the upper trapezius is effective in increasing the PPT in this muscle immediately after its application (p<0,01). It was also verified that the increase in the PPT in the upper trapezius, after the release of the LMTP, was accompanied by a simultaneous increase in the PPT in the contralateral upper trapezius, as well as in the elevator muscle of scapula bilaterally, GON bilaterally, CIII–IV articular processes bilaterally and V1 homolaterally. In both groups there was a significant increase in RANM (p<0,01). However, in the intervention group this increase was significantly higher, which may be quite relevant from a clinical point of view.
Conclusions. The release technique by pressing on the LMTP of the upper trapezius muscle is a useful technique in osteopathy, since it contributes to the increase in PPT and RANM immediately after its application.

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ISSN 2220-0975 (Print)
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