Introduction. Quantifying the spatial position of the sacrum is an important task for many medical specialties, including osteopathy. Knowing exactly how the patient′s sacrum is located is important for the correct osteopathic treatment. Digital radiography made it possible to process images of the entire spine and sacrum on a personal computer screen, without the patient′s participation.
The aim of the research was to determine the boundaries of the values of indicators of the spatial position of the sacrum from radiographs in the sagittal projection and investigate the frequency of three types of sacral position in young, elderly and senile people.
Materials and methods. Digital radiography of all parts of the spine was performed in 103 patients with dorsopathies. Group 1 — 32 patients aged 21 to 45 years, 15 men and 17 women; Group 2 — 50 patients aged 60 to 74 years, 16 men and 34 women; Group 3 — 21 patients aged 75–88 years, 6 men and 15 women. Combined digital X-ray images of all parts of the spine in the sagittal projection were obtained. From the point inion of the occipital bone, the occipital vertical descended, it served as the axis of the coordinate system for all measurements. To the contour of the base of the sacrum, and then to the contour of the dorsal surface of the body of the sacrum, tangents were drawn until they intersect with the occipital vertical. At the intersection point, a perpendicular was restored to each tangent. The angle between the perpendicular and the occipital vertical was measured. Two parameters were studied: angle α — the angle of inclination of the base of the sacrum; angle δ — the angle of the slope of the dorsal contour of the sacral body.
Results. The boundaries of the δ and α angle are determined, which allow us to attribute the spatial position of the sacrum to one of three types: vertical (δ=46–70°, α=8–31°), normal (δ=35–45°, α=20–37°) or horizontal (δ=15–34°, α=33–52°). It was revealed that in patients aged 21–45 years, the normal position of the sacrum was present in 44 %, horizontal — 28 %, vertical — 28 % of patients. At the age of 60–74 years, the normal position of the sacrum was determined in 46 %, horizontal — in 12 %, vertical — in 42 %. In patients aged 75–88 years, the normal position of the sacrum was diagnosed in 24 % of patients, horizontal — 10 %, vertical — 66 %.
Conclusion. The criteria for quantifying the spatial position of the sacrum are determined. The boundaries of these parameters are proposed, and it allows us to objectively register the type of sacral position. In elderly patients, the vertical position of the sacrum was detected ¹⁄³ more often than in young people. The number of patients with an upright position of the sacrum in old age is diagnosed more than 2 times more often than in young patients. This position of the sacrum was most common in this age group.

Introduction. Parkinson′s disease (PD) is a slowly progressive chronic disease and currently all available treatments are aimed at alleviating the symptoms of the disease and improving the quality of patients′ life. The main correction is drug therapy. Taking into account the progressive nature of the disease, the insuffi cient effectiveness of drug therapy, as well as early and frequent complications from drug therapy, the search for new pathogenetic and symptomatic drugs, as well as additional non-drug methods of treatment, is constantly being conducted. A number of authors have also previously demonstrated positive changes in the state of motor functions and regression of some neurological manifestations in PD patients with the use of certain osteopathic correction techniques. The above suggests that osteopathic correction may become one of the new directions in the treatment of PD within the framework of complex therapy.
The aim of the study is to substantiate the possibility of the inclusion of osteopathic correction of patients with Parkinson′s disease in complex therapy.
Materials and methods. A controlled, randomized prospective study was carried out at the Bakhrushin Brothers City Clinical Hospital and the «Ear, Throat and Nose Clinic» (Moscow) medical center from April 2019 to January 2020. The study included 24 patients aged 60 to 78 years with a diagnosis of Parkinson′s disease stage I–II according to Hoehn and Yahr. Depending on the applied treatment method, the patients were divided by simple randomization into two comparable groups (main and control) of 12 people each. All observed patients received common drug therapy and exercise therapy. Additionally, the patients of the main group underwent osteopathic correction (within 3 months, once every 14 days, a total of 6 sessions were performed). All patients, regardless of the group, underwent an osteopathic examination before and after treatment, with the formulation of an osteopathic conclusion; the quality of life was assessed according to the Medical Outcomes Study 36-Item Short-Form Health Survey, and the impact of motor and non-motor symptoms of PD on the daily activity of patients was assessed using the unifi ed PD assessment scale of the International Society of Movement Disorders (MDS UPDRS).
Results. The use of osteopathic correction together with drug therapy in PD patients leads to a statistically signifi cant (p<0,05) improvement in quality of life indicators (vitality scale and physical health scale) and daily physical activity (depression level). There is also a change in the structure of the dominant somatic dysfunctions (SD) in the form of a signifi cant decrease in the number of global SD.
Conclusion. To increase the effectiveness of complex therapy for patients with PD, the common drug therapy can be supplemented with osteopathic methods of correction.

Introduction. Anal incontinence (insufficiency of the anal sphincter) is a disease in which there is an uncontrolled discharge of intestinal contents through the anal canal when it is impossible to keep the episode of defecation to an acceptable place, which is a socially significant problem. Patients suffering from anal incontinence experience a feeling of psychoemotional inferiority and are often socially maladjusted. Insufficiency of the anal sphincter is a widespread pathology. The course of therapy is, as a rule, complex, and usually includes the use of medications, cleansing enemas, as well as non-drug methods of treatment (exercise therapy, massage, physiotherapy). At the same time, information on the possibility of including such a method of non-drug treatment as osteopathic correction in the complex therapy of anal incontinence in the available literature has not been found.
The aim of the research was to study the possibility of including osteopathic correction in the complex treatment of anal sphincter insufficiency in teenagers.
Materials and methods. The study involved 32 teenagers with functional anal sphincter incontinence, aged 14–17 years, undergoing treatment in the department of surgery. The patients were divided into 2 groups by the method of simple randomization — the main group (16 people, they received osteopathic correction in addition to the standard treatment) and the control group (16 people, they received only the standard treatment). At the beginning and at the end of the study there were assessed the osteopathic status and the disease severity using the Wexner scale and the Browning–Parks scale. The obtained results were analyzed by methods of nonparametric statistics.
Results. It was found that the inclusion of osteopathic correction in the complex treatment of teenagers with anal sphincter insufficiency is accompanied by a statistically significant (p<0,05) decrease in the severity of the disease. It was revealed that children suffering from anal sphincter insufficiency are characterized by a high frequency of detection of regional (pelvic region, lumbar region) and local (some skull sutures, rectum, ascending and descending colon) somatic dysfunctions. After osteopathic correction, the frequency of detecting regional and local dysfunctions in teenagers is statistically significantly lower (p<0,05) compared with children who did not receive osteopathic correction.
Conclusion. The obtained results demonstrated the ability to include the osteopathic correction in the complex treatment of teenagers with anal sphincter insufficiency.

Introduction. The relevance of the feet planovalgus deformity problem is caused by its prevalence and tendency to progression, insufficient knowledge of a number of aspects, and the complexity of treatment. Another urgent pediatric orthopedics problem is the placement torticollis in infants, and the possible relationship of this problem with feet planovalgus deformity. Among the least studied aspects of these diseases categories it is necessary to highlight the problem of the peculiarities of the osteopathic status in children with feet planovalgus deformity with a history of placement torticollis, and the dynamics of clinical manifestations during their osteopathic correction.
The aim of the research was to study the features of the osteopathic status in patients with planovalgus deformity of the feet in combination with a history of placement torticollis and without such a combination, and to evaluate the clinical efficacy of complex therapy, including osteopathic correction.
Materials and methods. The study involved 60 patients aged 7–14 years with planovalgus deformity of the feet. The study participants were divided into two groups. The first group included 30 patients with planovalgus deformity of the feet and a history of placement torticollis. The second group included 30 patients with planovalgus deformity of the feet, who did not have a history of torticollis. All study participants received complex therapy (orthopedic treatment and osteopathic correction). At the beginning and at the end of the course of osteopathic correction, the condition of the arch of the foot (the severity of fl at feet) and osteopathic status were assessed in all study participants.
Results. In the first group there were prevailed somatic dysfunctions (SD) of the head region, the detection rate was 86%, the pelvic region (somatic component — C), 76 %, and the neck region (C), 13 %. Among the second group participants there were prevailed SD of the pelvic region (C) — the detection rate was 100 %, the lower extremities, 43 %, and the lumbar region (C), 13 %. The SD in the pelvic region was the most typical; however, more often (p<0,05) this dysfunction was detected in the second group. The number of regional SD in general was statistically significant (p<0,05) more in the first group. The participants in both groups were most characterized by local SD of the vertebrae (76 and 100 %) and fibula (20 and 56 %). There was a statistically significant (p<0,05) difference between patients in terms of the detection frequency of these musculoskeletal system dysfunctions. Among the local SD of the craniosacral system and organs of the head, intraosseous SD (90 and 17 %) and SD of the dura mater (40 and 23 %) prevailed. SD of the temporomandibular joint was detected only in the first group (23 %). There was a statistically significant (p<0,05) difference between the groups in terms of the detection rates of temporomandibular joint dysfunctions and intraosseous dysfunctions. According to the results of treatment, the incidence of SD in the head region and the pelvic region decreased significantly (p<0,05) in patients from the first group, and in the SD of the pelvic region and the region of the lower extremities — in patients from the second group. The severity of flat feet of the study participants was not statistically significantly different before treatment. At the end of the complex treatment, the patients of the both categories showed a statistically significant (p<0,05) improvement in the state of the foot arch.
Conclusion. The revealed differences between the participants of the groups in the prevalence and number of regional dysfunctions and the prevalence of local SD could, presumably, reflect the relationship between the placement torticollis and planovalgus deformity of the feet. Based on the absence of differences in the degree of severity of flat feet between the participants of the groups, it can be assumed that the history of the placement torticollis is not associated by itself with the aggravation of the severity of feet planovalgus deformity.

Introduction. Somatic dysfunctions of the pelvic and sacral bones are one of the most common causes of lumbosacral pain with impaired spine statics, functional disorders of internal organs and other manifestations. Remote symptoms include torsional dural dysfunctions. Distortion of proprioceptive somatosensory afferentation blocks postural tonic reflexes of the axial skeleton and extremities, disrupts the sequence of activation of motor units of the locomotion system, changes the mechanisms for providing support and walking. Osteopathic correction of somatic dysfunctions in the region improves the condition of patients, however, in some cases, it is not possible to achieve complete regression of the identified syndromes. One of the effective corrective methods are computer technologies with the registration of the parameters of the static-dynamic function of support and maintaining balance. The possibilities of restoring reflex mechanisms can be obtained using computer stabilometry with a biofeedback program (BFB). Testing was carried out at the stage of diagnosis and follow-up: at the stage of screening, immediately after the treatment session, and 14 days after the moment of treatment. The clinical effect was compared with the results of stabilometric testing. The training sessions were carried out after registering the statokinesiogram.
The aim of the research was to study the possibilities of using a stabiloplatform with BFB in in the mode of diagnosis of coordination and static-dynamic disorders of the axial skeleton in patients with various types of somatic dysfunctions of the pelvic bones and in the training mode together with the osteopathic correction of the somatic dysfunctions identified in patients.
Materials and methods. In a prospective controlled study, the results of examination and treatment of 66 patients aged 23–56 years (median — 33) were analyzed, including 36 women and 39 men with somatic dysfunctions of the pelvic bones. In the main group, clinical and osteopathic signs of somatic dysfunctions of the pubic bone and ilium were revealed. The observation was carried out for 14 days. Osteopathic treatment of the corresponding type of dysfunction and stabilometric examination (3 control points) and training (3 sessions) were performed. Among the analyzed clinical manifestations, the intensity of pain syndrome and muscle-tonic reactions was taken into account. According to the results of the stabilometry, stability (RC) was assessed in the «eyes open» and «eyes closed» modes. The primary checkpoint is the start of observation and the correction procedure. Stage control after 7 days and the final observation point — 14 days. In total, 3–4 osteopathic sessions were carried out, stabilometric control was the screening stage, before and after the session, observation after 14 days from the last session.
Results. There was detected decrease in pain intensity, normalization of axial balance and coordination of movements. The most significant was the decrease in the Romberg coefficient in patients with dysfunction of the iliac bones in the anterior rotation, regardless of the side: dynamics on the right: decrease from 570±12 to 295±23 % and on the left from 550±22 to 260±25 % (p<0,05).
Conclusion. The combined use of osteopathic correction and physiotherapy exercises on a stabiloplatform in a training mode with BFB promotes regression of neurological and clinical symptoms, which is confirmed by all diagnostic methods used in the study — clinical neurological, clinical osteopathic, stabilometric with BFB. The best results were achieved in patients with somatic dysfunction anterior rotation of the ilium. The use of a stabiloplatform with BFB in the diagnostic mode allows obtaining objective data on the nature of the imbalance and balance disorders. The training regime contributes to the achievement of a therapeutic result in a short time (3 sessions) and can be used in inpatient and outpatient conditions of medical institutions.

Introduction. Currently, one of the directions in medicine is the study of the issue of the quality of life of patients. This indicator is a complex characteristic in terms of the physical and psychological component of health. The state of health is influenced by many factors and one of them is the peculiarities of the climatogeographic region where a person lives. The conditions of the Far North are characterized by extreme climatic and industrial conditions. In such areas, a rotational method is used, which assumes distance from the permanent place of residence. Thus, the influence of the climatic conditions of the Far North on the quality of life of respondents working on a rotational basis determines the relevance of this study, which was carried out in the Khanty-Mansi Autonomous Okrug — UGRA (KhMAO — Ugra).
The aim of the research was to study the quality of life of respondents working on a rotational basis in the Far North.
Materials and methods. Only men took part in this study — 207 people working in the conditions of the Far North (KhMAO — Ugra) on a rotational basis. All respondents were divided into four age groups: group 1 — 24–28 years old (n=36); group 2 — 29–34 years old (n=63); group 3 — 35–38 years old (n=78); group 4 — 39–45 years old (n=30). The duration of follow-up ranged from 1 to 3 months. A simple survey of all respondents was used to obtain information. In order to study the quality of life (QL) of those working in the Far North on a rotational basis, the MOS SF-36 questionnaire was used. Statistical analysis was performed using the STATGRAPHICS 12 Plus for Windows software in accordance with the general principles of QOL research in medicine.
Results. With a long stay in the Far North, a restructuring of the adaptive mechanisms is noted, which goes
through several stages: initially, minor physiological changes are noted that do not lead to serious changes in the body systems. The second stage is characterized by stable working capacity, but already there is a decrease in health indicators on all scales of the SF-36 questionnaire. The third stage or period of uncompensated fatigue is characterized by a significant decrease in psychological and physical indicators.
Conclusion. Unfavorable from the point of view of the medico-biological aspect in the work on a rotational basis in the Far North is the coincidence of the period of work with the phase of the greatest adaptation falling on the first month of stay in the North.

A number of physiological changes occurring in a woman′s organism during pregnancy includes, among other things, structural and functional changes in the musculoskeletal system, manifested by softening of the ligaments, cartilage, synovial membranes of the pubic and sacroiliac joints, and as a result, there is some discrepancy pubic bones, which contributes to the safe passage of the fetus through the natural birth canal during childbirth. However, these changes can cross physiological boundaries, leading to excessive relaxation of the pelvic joints, the occurrence of pain and the risk of divergence of the pubic symphysis during pregnancy and childbirth. Despite a fairly clear description of this condition, until now there is no unified terminology for pathological changes in the pelvic bones during pregnancy. In the Russian literature the terms such as symphysitis, symphysiopathy, divergence and rupture of the pubic articulation are accepted, but the most foreign authors suggest the term «pubic articulation dysfunction» to be used. However this term also does not fully reflect the essence of the pathological process. Despite the sufficient knowledge of the problem, the management of patients with this nosology still remains a rather serious task for clinicians. The problems of the isolated using and mutual compatibility of various non-drug methods have not yet been sufficiently studied, and the use of drugs is limited by the presence of pregnancy. A case from practice is described, devoted to the isolated use (monotherapy) of osteopathic correction in a pregnant woman in order to prevent rupture of the pubic articulation.

Using clinical examples, the article shows the use of the International Classification of Functioning, Disabilities and Health (ICF) in the practice of an osteopathic doctor. Somatic dysfunctions (structural and functional disorders) research, recorded according to the international classification of functioning in the form of a violation of «structure» and «function», make it possible to solve many issues of clinical and scientific osteopathy. This experience is useful for all rehabilitation professionals.

The article discusses the possibility of applying and using simulation training technologies in teaching osteopathy in residency programs, professional retraining in medical universities, and the methodology for constructing classes using simulation technologies.

There is presented a review of the literature on the concepts of «osteopathic damage», «somatic dysfunction», «trauma», «damage». The similarities and differences of these terms in osteopathy, traumatology and forensic medicine are shown. In order to achieve an interdisciplinary understanding in osteopathy, along with the original and new terminology, the use of the historically established terminology of classification of external damaging factors is proposed.

Introduction. Posterior Positional plagiocephaly (PPP) is a cranial deformation seen in infants. The case number increased since 1992, following the supine sleeping advice. Most of the time several factors are combining together, leading to a multi-level lack of mobility of the infant, thus leading to the cranial deformation. Studies show this deformation to be linked with perturbations in various fields.
Objective. This study aims to assess the efficacy of osteopathic care on the severity of the PPP.
Materials and methods. 100 infants were recruited in an osteopathic practice in Lyon (France). All the infants followed the same study protocol; however, the treatment was individualized. Three consultations occurred with a 15 days′ interval over 30 days′ period. Craniometric measurements were realized with Mimos® craniometer on each consultation.
Results. The mean severity of the PPP was 10,1 mm at Day 0. At day 30, this average was down to 6 mm. It is a significant (p<0,001) clinical and statistical decrease. Out of the 100 infants, 98 had a decreased deformation while two stagnated.
Conclusions. As every infant is unique, every plagiocephaly is different, thus the treatment was not standardised. This study suggest some effectiveness for osteopathic care in the cranial asymmetry of infants with PPP. Other studies should be done, some with a control group, in order to compare our results with spontaneous evolution of plagiocaphaly.