The editorial article discusses the main modern concepts and terms of osteopathy, including the concepts of preillness, somatic dysfunction and components of somatic dysfunction, and the principles of osteopathic diagnosis. The place of the «5P» concept of modern medicine in osteopathy is also considered.

Introduction. Acute disorders of cerebral circulation - strokes - are the most important medical and social problem, due to their high proportion in the structure of morbidity and mortality of the population, signifi cant indicators of temporary labor losses and primary disability. In this regard, one of the main tasks of Russian healthcare is to slow down the increase in the disability of the population, which is carried out through the active development of the rehabilitation system in our country, including neurorehabilitation. Osteopathic correction can become one of the new areas of rehabilitation for this group of patients. There have already been made previous attempts to study the osteopathic status in patients with acute cerebrovascular accident and to assess the possible contribution of somatic dysfunctions to the pathogenesis of this disease. At the same time, there are no publications in the available scientifi c literature about the possibility of osteopathic correction using in the rehabilitation of patients with acute cerebrovascular accident in the early recovery period. All of the above predetermined the purpose of the study.

The aim of the study is to substantiate the possibility of osteopathic correction methods using in the complex rehabilitation of patients with acute cerebrovascular accident in the early recovery period.

Materials and methods. A prospective randomized controlled study was conducted from February 2019 to March 2020 on the basis of the neurorehabilitation department of the State Clinical Hospital № 11 (Omsk). 40 patients with a diagnosis of acute cerebrovascular accident, early recovery period were under observation. The sample was entire. Patients, depending on the method of used treatment, were divided with using the method of simple randomization into two comparable groups of 20 people: main and control. All patients received complex rehabilitation treatment, which included drug therapy, physiotherapy, kinesiotherapy, massage, and acupuncture. Additionally, patients of the main group received osteopathic correction (3 sessions). All patients, regardless of the group, before the start, as well as after the completion of the rehabilitation course, were assessed for osteopathic status, the level of self-care, daily activity and mobility of patients was determined using functional scales, and muscle strength of the hands was studied using dynamometry.

Results. Patients with ischemic stroke in the early recovery period are characterized by the presence of somatic dysfunctions, mainly at the global and regional levels. 100 % of the examined participants had a global rhythmogenic cranial disorder. The most characteristic regional somatic dysfunctions were of the neck region, the structural component (29 %), and of the dura mater region (24 %). After completion of rehabilitation, global rhythmogenic cranial somatic dysfunction remained in all patients (100 %), however, in the group that received osteopathic correction, its severity was statistically signifi cantly reduced (p<0,05). Also, in the main group, the average number of regional somatic dysfunctions and their severity changed statistically more signifi cantly (p<0,05). At the background of complex rehabilitation treatment, all patients had an increase in the level of self-care, daily and physical activity according to neurorehabilitation scales, and also increased arm muscle strength according to dynamometry. However, in the group receiving additional osteopathic correction, these indicators were statistically signifi cantly higher (p<0,05).

Conclusion. Rehabilitation of patients with vascular pathology, including those with ischemic stroke, is one of the most important directions in the development of the modern healthcare system. This dictates the need to search and study new methods and means of rehabilitation, one of which could be osteopathy. This study showed that the inclusion of osteopathic correction in the program of complex rehabilitation of patients with ischemic stroke in the early recovery period will achieve better results in terms of restoring lost functions and improving self-care skills. In order to introduce the new method more widely, it is advisable to continue the study on an even larger sample.

Introduction. The presence of deformation of the lumbar-thoracic spine in the sagittal plane is the main factor determining the health status of adult patients. The studies of the features of human posture with or without spinal deformities in statics and movement have been in the focus of clinician attention for a long time. Recent studies offer a unifi ed approach to assessing the position of the vertebrae. However, no such studies have been conducted to analyze the lumbar-thoracic junction. The purpose of the work — to develop a method of qualitative and quantitative assessment of the vertebra positions in lumbar-thoracic junction. Issues: to develop a schematic model of the lumbar-thoracic spine; to develop a typology of the lumbar-thoracic transition; to develop an objective indicator refl ecting the features of the lumbar-thoracic transition in the patient; to characterize the age characteristics of this area of the spine.

Materials and methods. A study of digital radiographs for all spine parts in sagittal projection for 141 patients with dorsopathies, 57 men and 84 women aged from 21 to 88 years, was conducted. The study was performed on a personal computer screen, without patient participation. A single digital X-ray image of the spine in the sagittal projection was obtained for each patient. The occipital vertical and anteroposterior axes of TIX–LV (LVI) vertebrae (r axes) were applied to the combined radiograph. At the intersection points of the axes with the occipital vertical, the perpendiculars to the r axes were restored, and the angles between the perpendiculars and the occipital vertical (angles r) were measured. Statistical analysis was carried out using the Microsoft Offi ce Excel 2007 software package.

Results. Schematic models of the lumbar-thoracic junction for all cases were constructed on the basis of the data obtained. The models were used to compare the vertebra positions and describe three form types of lumbar-thoracic junction: normal, straightened and reinforced. An aggregated ArTL indicator is proposed and the boundaries of this indicator were determined for the quantitative assessment of each case. It is demonstrated that the age features for this part of the spine are expressed not in a monotonous change in the average value of ArTL with age, but in an increase in the proportion of patients with straightened and enhanced kyphosis, and it is especially noticeable in the group of people over 75 years old.

Conclusion. The proposed technology for assessing the position of the vertebrae of the lumbar-thoracic spine was developed to satisfy the needs of osteopaths and specialists in restorative medicine, and this technology is presented for the fi rst time. In the course of the study, schematic models of the spine of each patient were developed; an ArTL indicator was proposed to quantify the type of the lumbar-thoracic region shape. The boundaries for the diagnosis of each type were determined and a study was conducted to identify the age trend. The study revealed the absence of a linear age trend of changes in this part of the spine. Among people over 75 years of age, patients with straightened or enhanced kyphosis of this zone were more common.

Introduction. Pain in the chest area is characterised by the high prevalence in the population and the complexity of the differential diagnosis of the causes that induce this condition. The treatment of patients with pectalgic syndrome is mainly complex, more focused on drug therapy. At the same time, certain disadvantages of pharmacotherapy (potentially possible side effects, not always fully sufficient effectiveness) determine the relevance of the search for additional non-drug methods of influence. Osteopathic correction can also be one of these methods. From the standpoint of vertebroneurology, the causes of pectalgic syndrome are degenerative-dystrophic changes in the spine: at the cervical level the uncovertebral joints blockades have importance, and at the thoracic level — of the costovertebral joints. From an osteopathic point of view, the pain of the anterior chest wall is not limited by the spine pathology. It may be associated with dysfunction of the sternocostal joint, diaphragm, sternum, heart, pleura, liver, gallbladder, as well as disorders of other anatomical formations, including some structures located remotely from the initial localization of the pain syndrome. In students, pectalgic syndrome is not uncommon, and it is associated with certain features of their lifestyle, namely, prolonged static loads. Therefore, the study of possible additional non-drug, including osteopathic, methods for correcting this problem is especially important for this category of the population.

The aim of the study is to evaluate the osteopathic correction effectiveness of pectalgic syndrome in students.

Materials and methods. The study involved 40 young people, male and female, aged 18 to 22 years, suffering from pectalgic syndrome. Two groups were formed by simple randomization: the main group (20 people who received osteopathic correction) and the control group (20 people who received drug therapy, physiotherapy and exercise therapy). In both groups, at the beginning and at the end of the study, the osteopathic status, the severity of the pain syndrome, and the level of anxiety and depression were assessed.

Results. Study participants suffering from pectalgic syndrome were mostly characterized by the presence of regional biomechanical disorders (breast region, structural component — 100 % prevalence; neck region and lumbar region, structural components — prevalence of at least 50 %). Also, the study participants were characterized by a fairly pronounced pain syndrome (about 5–6 points by the 10-point VAS scale), and a subclinical level of anxiety (about 8 points by the HADS). After an osteopathic correction course, the main group participants were characterized by a statistically signifi cant (p<0,05) more pronounced decrease of the detection frequency of regional biomechanical disorders (chest region, structural component), the pain intensity, and the anxiety and depression level.

Conclusion. Osteopathic correction resulted in a signifi cant reduction of pain in the anterior chest wall — the main complaint of patients, and it could be associated with the elimination of somatic dysfunctions of the thoracic region. So it is permissible to propose the inclusion of osteopathic correction in the course of treatment of young patients suffering from pectalgic syndrome.

Introduction. Prolonged immobilization of the upper limb after various injuries leads to persistent contracture. Contractures of the upper limb joints are a severe orthopedic pathology that leads to a long-term decrease in working capacity and permanent disability. In the absence of treatment, the persistent changes in the articular elements can develop. Patients with contractures of the upper limb joints get treatment for a long time in polyclinics and hospitals, but the treatment does not always lead to the desired results. At the same time, an essential condition for treatment in outpatient medical institutions is the possibility of daily self-care and independent movement of the patient, as well as daily visits to a medical institution, but it is not always possible. In this regard, the search for treatment methods with comparable effectiveness, but requiring a signifi cantly smaller number of medical procedures and, accordingly, visits to specialized institutions, is relevant. Osteopathic correction could potentially be among these methods.

The aim of the study is to compare the effectiveness of osteopathic correction and standard complex rehabilitation of patients with post-traumatic contractures of the upper limb joints.

Materials and methods. The study involved 40 patients suffering from post-traumatic contractures of the upper extremities. Two groups were formed by the method of simple randomization: the main group (20 people who received osteopathic correction — 3 sessions with a frequency of 1 time in 7 days), and the control group (20 people who received standard complex rehabilitation, which included physiotherapy, physiotherapy exercises and mechanotherapy, daily for 10 days). The osteopathic status, the motion range of the upper limbs joints, and the hand muscles strength were assessed in all patients at the beginning and at the end of the study.

Results. A statistically signifi cant (p<0,05) increase in the motion range and the hand muscles strength was found in both groups at the end of the study. In patients of the main group, receiving osteopathic correction, a statistically signifi cant decrease (p<0,05) in the detection frequency of some regional and local somatic dysfunctions was observed.

Conclusion. The obtained results indicate the comparable results of the osteopathic correction of the upper limb joints post-traumatic contractures, and of the standard complex rehabilitation. Since osteopathic correction of post-traumatic contractures is carried out once every 7–10 days, it can be recommended for patients who, for various reasons, cannot regularly visit outpatient rehabilitation departments for a long time.

Introduction. The provision of medical care in the fi eld of osteopathy is a relatively new product on the Russian medical services market. And there are practically no studies on the problems of developing and increasing the competitiveness of osteopathic clinics, the impact on customer loyalty and minimizing possible claims to the services of osteopathic doctors.

The aim of the work is to assess the characteristics of consumer behavior when patients choose osteopathy as a method of treatment and a medical institution and the perception of quality in the osteopathic services market.

Materials and methods. The study included in-depth interviews with parents of children under the age of 14 who applied for treatment of their child. A total of 100 in-depth interviews were conducted. The in-depth interview research methodology included developing a scenario with questions, and interviewing respondents in compliance with the conditions of anonymity and the requirements for conducting marketing research of the international ESOMAR code. Projective questions and methods of working with metaphorical maps according to Zaltman were used to identify deep values and motivation for turning to osteopathic services. The assessment of the signifi cance of the identifi ed factors in assessing consumer requirements was carried out by ranking them using a score on a 10-point scale (10 points — maximum signifi cance, 1 point — no signifi cance).

Results. Most respondents perceive osteopathy as a scientifi cally proven method, systemic, complex therapy aimed at fi nding the causes of the disease and their solution, in which the result of treatment is completely dependent on the doctor. To meet the expectations of clients, the most signifi cant parameters are related to the personality of the osteopath, his competence, behavior during the procedure and his reputation, as well as the safety, convenience and comfort of staying in the clinic, especially for children. The organization of the work of an osteopathic clinic, taking into account the above, will ensure a high level of consumer demand and organize a marketing policy and promotion of medical services in osteopathy, taking into account current trends.

Conclusion. Key patterns of consumer behavior of clients and motives for seeking osteopathic treatment have been identifi ed. The results of the study will allow more effective interaction with people who seek treatment, as they give an understanding of what they are guided by when applying, what is important to them in terms of values and rational benefi ts, what expectations they have from visiting an osteopath.

Introduction. Spinal anesthesia (SA) is one of the most versatile and reliable methods used for pain relief in obstetric patient groups. However, like any other method of anesthesia, spinal anesthesia in some cases can be associated with the risk of complications and side effects. These effects may include developing functional disorders (somatic dysfunctions), timely diagnosis and correction of which can prevent the development of pathology. Evaluation of the impact of SA on the osteopathic status of patients, as well as the use of non-drug methods (including osteopathic correction) for treating side effects after using SA, taking in consideration the lack of the possibility of using drug correction methods in the postpartum period, has an interest to the practitioner. The aim of the study is to study the osteopathic status of maternity patients (puerperas) after spinal anesthesia and the possibility of its osteopathic correction.

Materials and methods. The study involved 140 women aged 20 to 30 years with a pregnancy of 38–41 weeks. Three groups were formed by simple randomization: the main group (50 people, participants received spinal anesthesia during childbirth and osteopathic correction after childbirth), the control group (50 people, participants did not receive spinal anesthesia during childbirth, but received osteopathic correction after childbirth), and comparison group (40 people, participants received spinal anesthesia during childbirth, but did not receive osteopathic correction after childbirth). All participants were assessed for osteopathic status and the presence of soreness during palpation at typical painful points. The examination was carried out three times: before childbirth, after childbirth, and after the course of correction in the main and control groups (in the comparison group, this was, respectively, the second postpartum examination).

Results. In the postpartum period, the participants of the main group and the comparison group (who received SA) were characterized by a statistically signifi cant (p<0,05) increase in the detection frequency of global rhythmogenic cranial disorders compared with the initial (prepartum) values. At the time of the fi nal examination, there were no signifi cant differences with the initial values. During all stages of the study, biomechanical disorders of the following regions were most characteristic for its participants: thoracic (structural component), lumbar (visceral and structural component), pelvis (visceral and structural component). In the control group, there was a statistically signifi cant (p<0,05) increase in the detection frequency of somatic dysfunctions (SD) in the lumbar region (visceral component) after childbirth, compared with baseline indicators. After osteopathic correction in this group, the detection frequency of these disorders did not signifi cantly differ from the initial values. In the main and control groups, a statistically signifi cant (p<0,05) decrease in the detection frequency of SD in the pelvic region (structural component) was found after the correction, compared with the initial values. After childbirth, an increase in the amount of SD in the dura mater region was observed in the main group and the comparison group. During this period, there was a statistically signifi cant (p<0,05) more frequent detection of dura mater SD in the main group compared with the control group. At the fi nal examination, dura mater SD was detected in all groups almost as rarely as before childbirth.

Conclusion. The regional somatic dysfunctions of the thoracic, lumbar, and pelvic regions were the most characteristic for the examined puerperas. Postpartum women who received spinal anesthesia during childbirth are characterized by an increase in the detection frequency of global rhythmogenic cranial disorders and regional biomechanical disorders of the dura mater after childbirth. Postpartum women who did not receive spinal anesthesia during childbirth are characterized by an increase in the detection frequency of regional biomechanical disorders in the lumbar region (visceral component) after childbirth. After osteopathic correction, the frequency of detection of these disorders decreases almost to the baseline. Osteopathic correction is accompanied by a decrease in the detection frequency of disorders of the pelvic region (structural component) compared with the initial values, both in puerperas who received spinal anesthesia and in those who did not receive it.

Introduction. Recently, the prevalence of functional disorders of the digestive system (FD DS) in children has increased. Regurgitation is one of the most common manifestations of FD DS, but also one of the symptoms of perinatal damage to the nervous system (PD NS). The most diffi cult diagnosis of FD DS is in newborns and children of the fi rst half of life, since there are age restrictions in the use of instrumental research methods. Osteopathic diagnostics of somatic dysfunctions can complement clinical and instrumental research methods in such children. No studies have been conducted to assess the osteopathic status of children in the fi rst six months of life with FD DS and PD NS. The aim of the study is to assess the osteopathic status of children in the fi rst six months of life with regurgitation and to compare the osteopathic status in children with functional disorders of the digestive system or perinatal NS damage.

Materials and methods. There were examined 50 children aged 1 to 6 months with regurgitation. The patients were divided into 2 groups of 25 people in accordance with the criteria for inclusion in the study — the presence of a diagnosed FD DS or PD NS, vegeto-visceral syndrome. Anamnestic information was collected. A single osteopathic examination was conducted, according to the results of which the osteopathic status of children of both groups was compared.

Results. It was found that regional somatic dysfunction of the neck region (somatic component) and local somatic dysfunctions of the thoracic diaphragm and sigmoid colon are the most common in the group of children with FD DS. Regional somatic dysfunctions of the head and neck region are the most common in patients with PD NS and vegeto-visceral syndrome, which could be associated with the development of central nervous system pathology.

Conclusion. The obtained results allow to recommend the osteopathic diagnostics to clarify the possible cause of regurgitation with an aim to its subsequent osteopathic correction in children of the fi rst six months of life with FD DR and PD NS.

Introduction. The use of orthodontic treatment is becoming more and more common in the modern world. At the same time, it becomes acute to develop methods for identifying patients with an increased risk of undesirable side effects of treatment (pain, dysfunction of the temporomandibular joint, root resorption, etc.). The aim of the study is to investigate cervical-oral synergies in patients undergoing orthodontic treatment and compare it with their osteopathic status.

Materials and methods. 154 patients examined by an orthodontist were selected for the study and divided into 2 groups: Norm and Dyskinesia — according to the difference in the mouth opening width (the opening width in the extensional position minus the width in the neutral position of the head, E–N). The mouth opening width was measured by a caliper with thin lips. The Norm group included 86 people with a positive E–N difference, and the Dyskinesia group included 68 with a negative E–N difference. The patients age was the same in both groups (p>0,05). There were 31 % of men in the Norm group, and 16 % in the Dyskinesia group. In both groups, the angle of neck extension with open and closed mouth was measured, and the osteopathic status was assessed. At the same time, the osteopathic physician did not know which group the patients belonged to.

Results. The groups differed signifi cantly by the difference of the width mouth opening (p<0,000001), and it indicates the correctness of the choice of this sign for the groups separation. The absolute value of the mouth opening width in the neutral position did not differ statistically signifi cantly between the groups, and it was slightly below the norm of 49–50 mm (42 mm in the Norm group and 39 mm in the Dyskinesia group). The difference in the extension of the cervical spine with an open and closed mouth was also calculated (the angle of extension with an open mouth minus the angle of extension with a closed mouth). A statistically signifi cant difference between the groups was obtained (p<0,0001). Absolute values of neck extension did not differ statistically signifi cantly in the two groups. During the osteopathic examination, there was found a statistically signifi cant (p<0,05) difference of the detection frequency of the following somatic dysfunctions (SD): SD of the neck region, the somatic component, in the Norm group in 34,1 % and in the Dyskinesia group in 57,4 %; as well as global SD: in the Norm group there were diagnosed only in 3,5 %, and in the Dyskinesia group — in 14,7 %.

Conclusion. Thus, patients with a negative E–H difference (the Dyskinesia group) differ statistically signifi cantly from patients with a positive E–H difference in the difference of the movements′ volume in the neck, and by the set of somatic dysfunctions. The osteopathic status of these patients may cause a disorder of cervical-oral synergies. The measuring the width of the mouth opening in different positions of the head and calculating the difference in E–H could be used as an indicator that the patient needs correction of somatic dysfunctions during orthodontic treatment. It is planned to further study these synergies in relation to the practice of a dentist.

The problem of the headaches occurrence is currently relevant among medical specialists of various profi les due to the fact that this symptom does not have a clear etiopathogenetic picture, and when patients come in with such a complaint, it sometimes requires a rather complex differential diagnosis. This is especially true for certain types of headaches (for example, facial pain — prosopalgia), the diagnosis of the causes of which is diffi cult due to the possible involvement of the ENT organs, the organ of vision, the dentoalveolar system and, of course, due to the complex system of innervation. Despite the fact that a lot of attention has been paid to this issue in the literature, there are still many such patients, and in a large number of cases this reduces not only their ability to work and life quality, but also brings signifi cant socio-economic damage to the whole society. The question of competent and effective care for this category of patients remains open, since often complex drug treatment does not bring the desired result, or it brings a temporary positive effect, and all these open up opportunities for the introduction of non-drug approaches, both in the form of monotherapy and in the form of combined treatment, taking into account features of the pain syndrome course and its occurrence causes in each patient individually. The article describes a clinical case from practice devoted to the isolated use of osteopathic correction in a patient with symptoms of prosopalgia.

Objectives. The study aims to conduct a systematic literature review about effi ciency of osteopathic care on health problems of the infants, from birth to the age of two, as well as to list eventual associated side-effects.

Materials and methods. An independent author realized a systemic literature review among 10 data-bases. Studies investigating the effi ciency of osteopathy on troubles affecting premature babies, newborns, and infants, as well as associated adverse effects were included as long as they were written in French or in English. Case studies and experts′ point of view were excluded.

Results. 12 studies out of 62 could be included. They looked at infant′s obstructive apnoea, lingth of stay and gastrointestinal disorders of the premature infant, positional asymmetry, infantile colic, and breastfeeding disorders. Mild side-effects are the only ones recorded to this day, although there is a lack of data on that count.

Conclusion. To this day, there is a lack of studies with adequate methodology allowing to demonstrate the effi ciency of osteopathic care on aforementioned troubles. However, the experimental protocols in some of the studies found will provide a good basis to develop future randomized controlled studies investigating: troubles cared for, type of care provided, effects and potentially related adverse effects.