The article presents the main osteopathic tests that allow identifying and differentiating biomechanical, hydrodynamic and neurodynamic components of somatic dysfunctions and choosing adequate techniques for osteopathic correction. For each test, an anatomical and physiological justifi cation is given and the principle of its implementation is described.

Introduction. The increase in the number of elderly and senile people is recognized as a global problem, therefore, the development of new indicators that objectively reflect the aging of the human body is an urgent and significant task. However, the available quantitative indicators and methods used in the field of aging, according to WHO estimates, are limited and do not provide a deep understanding of the key aspects of healthy aging. This article offers information about the possibilities of studying the panoramic X-ray image of the entire spine for developing some new indicators and evaluating the age-related changes observed.

The purpose of the work: to investigate the age-related spine changes on the basis of previously developed criteria for quantitative and qualitative assessment of the shape and position of the spine structures.

Materials and methods. X-ray images of all spine parts were examined in the sagittal projection for 141 patients, 57 men and 84 women with dorsopathies. The selection of patients was carried out randomly. The cohort of patients was divided into 4 groups: 1st — 21–44 years (average age 32,7 years) — 31 people, 2st — 45–59 years (average age 52,6 years) — 39 people, 3st — 60–74 years (average age 66,8 years) — 50 people and 4st — 75–88 years (average age — 81,1 years) — 21 people. The study was carried out on a personal computer screen, without the participation and additional irradiation of patients. A digital X-ray image of the whole spine in the sagittal plane was obtained for each patient. On the combined digital radiograph the occipital vertical was drown starting from the outer hillock of the occipital bone along all spine parts. The anteroposterior axes of CV–TV vertebrae (r axes) were drawn and the tangent line segments were applied on the contours of the base and dorsal planes of the sacral image. The angles were measured between the occipital vertical and the perpendiculars restored to these lines at the points of their intersection with the occipital vertical. Statistical processing of the data obtained was carried out.

Results. In the course of statistical processing on the basis of the data obtained, some distinctive features of the studied structures were identified, methods of their quantitative assessment were proposed and boundaries of the proposed indicator registration were determined. The peculiarities of changes in the position of the spine depending on age are revealed: for people over 70 years, the occipital vertical most often passes anteriorly from the anterior contours of the bodies or crosses the bodies of the thoracic vertebrae; for people over 60 years, the cervical-thoracic transition at the CVII–TIII  level more often has the form of enhanced kyphosis («Bear withers» or «Buffalo hump» type), and the head is in a forward position (FHP); for people over 70 years, the sacrum more often has an upright position.

Conclusion. The proposed diagnostic method made it possible to determine position type of the spine structures and to characterize the age-related spine changes.

Introduction. Due to the high prevalence of caries, the monitoring of enamel and dentin state remains an actual problem in dentistry and contributes to the development of new methods for diagnosing and predicting a cariogenic situation in the oral cavity. One of these methods is the study of the remineralization and demineralization processes in the oral cavity and of the microelements′ and macroelements′ level in the oral fluid.

The aim of the study is to research the level of macroand microelements in the oral fluid in patients with different intensity of dental caries.

Materials and methods. 13 people aged 21 to 35 were examined, including 10 women and 3 men. Based on the results of the dental examination, 2 groups of subjects were formed: 1st (n=4) healthy individuals and patients with a compensated form of caries; 2st (n=9) patients with decompensated form of caries. The subjects collected oral fluid by spitting into a test tube on an empty stomach, after brushing their teeth and rinsing their mouth three times with distilled water. Three samples were taken from each subject on different days, a total of 39 samples. The content of elements (Na, K, Ca, Mg, Fe, P, Mn) was determined by inductively coupled plasma atomic emission spectrometry.

Results. An increase in the content of most microand macroelements (Na, K, Ca, Mg and P) in the oral fluid was found in patients with decompensated caries compared with the compensated form and healthy people (p<0,05). Perhaps, in the absence of a carious process or compensated caries, the mineral components are concentrated in hard tissues and the remineralization-restoration processes of the tooth mineral structures prevail.

Conclusion. The study of the content of Na, K, Ca, Mg and P in the oral fluid can be used to diagnose and predict the course of the carious process.

Introduction. The development of pregnancy is accompanied by a number of regular structural and functional changes in a woman′s body, which, in turn, can both reduce the level of life quality and serve as a background or a cause for the formation of somatic dysfunctions, the level of manifestation and severity of which depend on the compensatory capabilities of the female body. Therefore during this period a woman needs to ensure a high level of life quality. At the present stage the pregnancy′s support dictates the need to use an integrated approach to solving the issues of preventing the development of complications during pregnancy, as well as reducing perinatal risks for the mother and fetus. At the same time, issues of the life quality of pregnant women are often not given due attention. This dictates the need to search for methods (primarily non-drug) that contribute to improving the life quality.

The aim of the study was to evaluate the impact of osteopathic correction on the life quality of pregnant women.

Materials and methods. A prospective controlled randomized study conducted in the period from 03.2018 to 03.2022 on the basis of the Mokhov Institute of Osteopathy LLC Medical Clinic included 90 somatically healthy pregnant women aged 25–45 years, whose gestation period was 13–27 weeks. All pregnant women, depending on the used correction technique, were divided by a randomization envelopes method into three groups: the main (30 people), control (30 people) and comparison group (30 people). The patients of the main group received osteopathic correction (3 procedures with an interval of 10–14 days). The control group patients used physical exercises 2 times a week for 1,5 months as prescribed by a physical therapy doctor. The patients of the third group were dynamically monitored. Before and after the correction an osteopathic examination of all pregnant women was conducted with the formation of an osteopathic conclusion, and also their life quality was assessed according to the criteria of the SF-36 questionnaire.

Results. For pregnant women, as the pregnancy period increases, a decrease in both the physical and psychological components of the life quality is characteristic. In the main group, compared with the control group, after osteopathic correction, there was a statistically significant increase in the indicators of the physical and psychological components of the life quality (p=0,0024). The use of physical therapy exercises by healthy pregnant women leads to the fact that quality of life indicators tend to increase as pregnancy progresses.

Conclusion. The development of pregnancy is accompanied by a number of regular structural and functional changes in a woman′s body, which in turn can reduce the quality of life. The use of osteopathic correction during pregnancy makes it possible to improve the life quality of pregnant women, and so it can be used to improve medical care for this contingent of the population.

Introduction. The risk of unsuccessful intubation is a signifi cant problem during elective surgical operations with general anesthesia and tracheal intubation. Taking in consideration the trend towards the development of short-stay surgical hospitals, and the rather low availability of endoscopy services, the search for alternative methods of preparing patients for successful tracheal intubation is in demand. A normal tone of the muscles involved in the work of the temporomandibular joints as well as the tone of the muscles above the hyoid bone and the muscles below the hyoid bone are necessary for successful intubation of the trachea. Based on modern ideas, it can be assumed that an adequate osteopathic effect on the mentioned anatomical structures can provide a decrease in muscle tone. However, there are no publications in the available literature on osteopathic correction of patients at high risk of intubation in order to reduce the risk degree.

The aim of the research is to substantiate the use of osteopathic correction in the planned preparation of patients for general anesthesia with tracheal intubation.

Materials and methods. The study involved 30 patients with chronic surgical pathology of internal organs who had to undergo elective surgery. The patients were distributed into the control and main groups (15 participants each) by the method of randomization envelopes. The participants of the control group followed the instructions given by the anesthetist, the participants of the main group received additionally a month before the operation two sessions of osteopathic correction with an interval of 14 days. In both groups, the osteopathic status was assessed before the start of the corresponding treatment. The degree of intubation risk and the incision distance were also assessed. After completion of the corresponding treatment, the osteopathic status was re-evaluated in both groups. In the main group, the risk of intubation and the incision distance were re-evaluated.

Results. At the beginning of the study, both groups were characterized by a high detection frequency of the following regional biomechanical disorders: neck, thoracic region and dura mater. At the completion of the study, a statistically signifi cant (p<0,05) decrease in the detection frequency of all these disorders was observed in the main group. There was no signifi cant dynamics in the control group. Also in the main group there was a statistically signifi cant (p<0,05) decrease in the intubation risk and an increase in the incision distance value.

Conclusion. The obtained results allow recommending the appointment of an osteopath consultation and osteopathic correction during the planned preparation of patients with a high risk of intubation. At the same time, it is recommended to continue the study on a larger sample.

Introduction. Valgus deformity of the Ist toe (hallux valgus) is a multicomponent deformity of the forefoot, which is the most common reason for visiting orthopedic surgeons. By now, there is idea that the hallux valgus development has a complex polyetiological and polypathogenetic nature. It makes a complex approach to treatment with the inclusion of methods focused on a holistic approach to body′s complex biomechanical systems in demand. One of such well-established and validated approach is osteopathy.

The aim of the study is to investigate the effectiveness of osteopathic correction of hallux valgus of the Ist toe of the I–II degree.

Materials and methods. The study involved 52 patients with valgus deformity of I toe, aged from 18 to 40 years. Two groups were formed by randomization envelopes method: the main group (26 participants who received osteopathic correction) and the control group (26 participants who received imitation of osteopathic correction). At the beginning and at the end of the study, the osteopathic status and severity of clinical manifestations of hallux valgus of the first finger were assessed (using the AOFAS questionnaire and the clinical-radiological Grulier scale, as well as radiography of the feet with a load in a direct projection).

Results. Patients with valgus deformity of the Ist toe are characterized by the presence of global postural disorders, regional biomechanical disorders of the head, neck regions (structural and visceral component), lumbar and pelvic regions (structural and visceral component), as well as dura mater. Local somatic dysfunctions of the musculoskeletal system (tarsal-metatarsal and metatarsal-phalangeal joints, diaphragm, foot bones) and craniosacral system (temporomandibular joint, TMJ, skull sutures) were also revealed. Osteopathic correction is accompanied by a statistically significant (p<0,05) decrease in the frequency of detection of all listed regional disorders (except for the lumbar region, structural component) and most local (except for local TMJ dysfunctions). Global postural disorders are not detected after the correction. The clinical manifestations severity of valgus deformity of the first finger decreases statistically significantly (p<0,05), by such parameters as the interplatarsal angle value (from 12 to 11,4 degrees on average) and the valgus deviation of I finger angle (from 21 to 20,3 angles on average); the AOFAS questionnaire indicators also improve (from 56,4 to 77,5 points on average) and the Grullier scale (from 48,2 to 67,7 points on average) too.

Conclusion. The results obtained during the study allow to consider the possibility of recommending the inclusion of osteopathic correction in the complex conservative treatment of hallux valgus of the Ist toe.

Introduction. According to Russian and foreign studies, the frequency of clinical manifestations that are character for post-COVID syndrome continues to grow in people who have undergone a new coronavirus infection. In this regard, an urgent task is to increase the volume of available treatment methods, including non-drug ones, and their reasonable inclusion in medical rehabilitation.

The aim of the study was to assess the osteopathic status and complaints in people who had a new coronavirus infection 3-6 months after the disease and their changes after osteopathic correction.

Materials and methods. In the period from May 2020 to September 2021, a prospective study was carried out at the bases of the medical part of the rotational camp of the Yamal-Nenets Autonomous Okrug and ANO «Tyumen Institute of Manual Medicine», Clinic of Family Osteopathy of Doctor Aptekar′. The work is based on the results of osteopathic correction of 218 patients aged 27–54 years (average age — 42,3±3,2 years) who had a new coronavirus infection 3–6 months before the start of the study and who have clinical symptoms that are character for post-COVID syndrome. All patients underwent an assessment of osteopathic status, and there was an analysis of medical records.

Results. During the process of osteopathic diagnosis in the examined group, prior to treatment, there were revealed dominant somatic dysfunctions of the regions of the head, thoracic and lumbar. The following most significant local disorders were diagnosed in regional somatic dysfunctions: compression of sphenobasilar synchondrosis (29,8 %), somatic dysfunction of the dura mater of the Brain sag type (25,2 %), somatic dysfunctions of the abdominal (6,9 %) and pelvic (6 %) diaphragms, sigmoid colon (6,9 %) and pericardial ligaments (15,1 %). At the same time, patients had complaints indicating a violation of cognitive functions, disorders of the nervous, cardiovascular, respiratory systems and the musculoskeletal system. After the completion of osteopathic correction, the detection frequency of the above dysfunctions decreased statistically significantly (p≤0.05), and there was obtained a statistically significant (p≤0,05) positive dynamics in complaints. Positive dynamics persisted 3 months after the completion of the osteopathic correction course.

Conclusion. This study made it possible to establish that in people who had a new coronavirus infection, in the period 3–6 months after the disease, the compression of sphenobasilar synchondrosis, somatic dysfunction of the dura mater (according to the Brain sag type), somatic dysfunction of the thoracic and pelvic diaphragms, sigmoid colon and pericardial ligaments were the most often detected. After the osteopathic correction, patients showed a statistically significant (p≤0,05) decrease of the detection frequency of these somatic dysfunctions, and a positive trend in complaints.

Introduction. Shoulder joint′s dislocation stands first among all dislocations. Assistance to patients with dislocation of the shoulder carries out both outpatient and inpatient. The cost of inpatient treatment is many times higher than that of outpatient care.

The aim of the study is to substantiate the economic efficiency of the author′s manual technique for shoulder dislocation repositioning.

Materials and methods. The study is longitudinal from 2013 to 2020 inclusive, the sample is continuous, the place of the study is the trauma center of the City Hospital № 1 N. I. Pirogov. Criteria for inclusion of patients in the study — primary dislocation of the shoulder. Diagnosis closed traumatic dislocation of the shoulder in total — 1 968 people. Non-inclusion criteria — secondary dislocation. Successful repositioning of shoulder dislocation on an outpatient basis was performed in 1 159 (58,9 %) patients; after unsuccessful repositioning, 809 (41,1 %) patients were hospitalized with shoulder dislocation. Outpatient patients were randomly divided into 2 groups: group 1 — patients (n=1 552) underwent reduction of the dislocation using traditional methods using local anesthesia, in group 2 patients (n=416) the author′s manual technique was used without local anesthesia. There were no statistically significant differences in gender, age, and type of dislocation in both groups. The effectiveness of using traditional methods with the use of local anesthesia was 52% (dislocation was repositioned in 807 patients), the rest of the patients were treated in an inpatient setting. The use of manual techniques was effective in 84,6 % of cases (352 people), 64 people were hospitalized (15,4 %).

Results. Comparison of the cost of treatment was carried out on the basis of the Tariff Agreement in the compulsory medical insurance system of the Sevastopol city dated December 20, 2021: the cost of treating one patient with shoulder dislocation in the traumatology department (13 582,49 rubles) is 13,3 times more than in the trauma center (1 019,5 rub). The effectiveness of the author′s manual technique is 1,63 times higher than the use of standard reduction methods using local anesthesia.

Conclusion. The use of the author′s manual technique in patients with shoulder dislocation on an outpatient basis has a higher efficiency compared to traditional methods due to the fact that more patients receive assistance on an outpatient basis, the cost of this service is much cheaper than inpatient treatment. In addition, this type of treatment is carried out without anesthesia, which also reduces the cost of treating of this category of patients.

The new coronavirus infection probably affects the pathomorphosis of the disease, aggravating the course of the tension headache that the patient previously had. In the above clinical observation, the high effectiveness of the complex treatment of TH and autonomic dysfunction with central thermoregulation disorder in the framework of postcovid syndrome with the use of osteopathic correction, acupuncture and drug treatment was noted. The effectiveness of osteopathic techniques can be reinterpreted and explained through the identification of the glymphatic system. Further studies are needed to clarify the main mechanisms of action of osteopathy in patients with the consequences of a coronavirus infection.

Currently, back pain ranks fourth among the causes of disability of the population. Lumbar pain and pain in the lower back are the most common among the pain syndromes. Tunnel neuropathies of the pelvic girdle including piriformis syndrome are among the particular manifestations of this pathology. The purpose of this article was to summarize modern ideas about the etiology and pathogenesis, diagnosis and treatment of piriformis syndrome.

Due to the high incidence of non-specific low back pain in the world population that don′t present a response with conventional tools, a quantitative register is sought, through a Balanced Ligamentous Osteopathic Technique, that responds to its effectiveness on the ligaments iliolumbar elongated by the vertebral injury, that is, the correction of a second-degree injury of the 5th lumbar. The purpose of this study was to determine if there is a decrease in local pain and an increase in trunk flexion movement in Lumbosacral Hinge after applying the Balanced Ligament Osteopathic Technique on the transverse apophysis of the 5th lumbar and to emphasize the importance of the treatment of ligament structures in the specific biomechanical integration of the entire spine. This design consisted of two groups, an experimental one that received the treatment detailed in the present work, while the second group was the control group, which received a placebo intervention. It was made up of two groups, one of an experimental type, of 72 participants, who received the treatment detailed in the present work, while the second group of other 72 participants, was the control group, which received a placebo intervention. Quantitative pain values were taken through the Algometer (local pain) and the ground finger test to record the presence of the limits that pain generates for the trunk flexion movement. The ground finger test resulted in an increase of 62,6 % for the experimental group and 6.7% for the control group, before and after the intervention. The same occurred in the Algometer record before and after the intervention, giving a 133 % increase in tolerance to pressure in the experimental group and in the control group it did not exceed 1 %.