Manual Therapy

N.I. Pirogov Russian National Research Medical University. Department of Neurology, Neurosurgery and Medical Genetics with the manual therapy course of the Department of Postgraduate Professional Training, Moscow, Russia The Manual Therapy Center - a branch of the City Clinical Hospital No. 67 of the Department of Health of Moscow, Russia

Damages to the structure and function of the rotator cuff can cause severe shoulder pain and disability. Treatment options include physical therapy or surgery, although there are not enough studies comparing these treatment options. To date, physical therapy provides an uncertain treatment outcome that needs to be combined with other methods for progress of the patient's quality of life. Given these significant research gaps, it is difficult to advise the best mono-treatment method for clinicians who treat patients with massive rotator cuff injuries, so a comprehensive approach to this problem is being studied. As yet, it is not certain that surgery to repair the rotator cuff has clinically meaningful benefit for people with tear symptoms; it may provide little or no benefit in terms of pain intensity, functionality, overall quality of life, according to patients, as compared to non-operative treatment. Surgery may not relieve shoulder pain or functionality compared to exercise, with or without glucocorticoid injections. There is growing evidence for physical therapy as a treatment method for subacromial shoulder pain. Further research is needed to make recommendations on the type of exercise, its dosage, duration and expected outcomes. It is safe to recommend the inclusion of manual therapy at the initial phase of treatment [19].

Today, the COVID-19 pandemic has receded, but its problems have remained, and now much attention is paid to the consequences of the coronavirus infection. Pain is a common complaint in children, although it is not always given its due importance. Pain syndrome causes tension of the body's regulatory systems, which can lead to delays in speech development, cognitive impairment and movement disorders, which contribute to a significant decrease in the quality of life of children and parents. The article describes a clinical case of a child with pain syndrome after COVID-19 coronavirus infection. The girl had moderate pain (6 points according to FLACC-SS) preventing active rehabilitation. After osteopathic correction of somatic dysfunctions, the pain was completely relieved, and active rehabilitation became possible. As a result, the girl began to breathe better, attacks of shortness of breath during sleep and coughing during the day stopped, which made it possible to cancel inhaled hormone therapy completely. Her sleep has restored, her appetite has improved, she gains weight, and she has become calmer when communicating with strangers. According to the results of cardiac intervalography, the predominance of the tone of the sympathetic nervous system was replaced by eutonia. The proposed rehabilitation program with the inclusion of osteopathic correction leads to a decrease in the level of pain syndrome, restoration of the body’s compensatory capabilities, restoration of the physiological breathing pattern.

Based on the dynamic parameter of cerebrospinal fluid flow, the article provides an original formula for assessing the pathology of the spinal motion segments of the spine. Graphs are given that clearly show the change in the pathology depending on the depth of injury. The data obtained will be useful to specialists in radiation diagnostics who currently describe the pathology itself in a simplified manner.

The article includes data of the report that has been presented at the congress with international participation OSTEOPATHY OPEN 2024 “Osteopathy in Russia and in the world: history and modernity” held in Saint-Petersburg. Pathophysiological aspects of pain and the possibility of application of osteopathic medicine to relieve them are considered. The results of the use of osteopathic techniques in 650 patients with pain syndromes are presented, the effectiveness of this treatment is shown, and the possibility and rationality of the osteopathic approach as a pathogenetic method of pain relief is substantiated on the basis of the results presented.

Multidisciplinary treatment [25,28] with careful consideration of conservative treatment methods [21,22,37] is recommended for patients with temporomandibular joint dysfunction. Treatment of this dysfunction requires combined skills of physiotherapists and dentists, as well as sometimes psychologists and other medical specialists [6,21,24,35]. The combination of treatment methods often produces better results. For example, superficial electromyography in combination with physiotherapy or a combination of manual therapy with an occlusal splint and counseling in the treatment of temporomandibular joint dysfunction result in an improvement of more than 90% [33]. Although all these therapeutic approaches have been shown to positively influence central sensitization of temporomandibular joint pain, there is still no consensus in the scientific literature on this issue, and randomized comparative clinical trials are required [18].

The article analyzes national and foreign publications presented in Elibrary, PubMed and Cyberleninka scientific databases, mainly over the past five years, and also summarizes the data obtained, in which osteopathic techniques are considered not as an alternative but as an integrative component of the evidence-based non-drug therapy.

Regional myofascial syndrome with median nerve irrigation (Sudeck syndrome) is considered as the pathomorphological basis of the myofascial and ligamentous pain syndrome of the upper quadrant region with pathological involvement of forearm rotators and irrigation of the median nerve which contains a large number of sympathetic fibers. Stage 1 is blocking of the first rib with irritation of the stellate ganglion and simultaneous blocking of the elbow joint with the formation of myofascial pain syndrome in the forearm rotators; stage 2 is regional myofascial syndrome with irritation of the median nerve in the upper third of the forearm in the fibromuscular canal; stage 3 is completion of the development of vegetative-irritative typical complex regional pain syndrome of the arm.

This study evaluated the effectiveness of osteopathic therapy for hyperkinetic biliary dyskinesia against the background of psychoemotional stress in women of reproductive age. A prospective comparative analysis was conducted involving 30 patients randomized to the main group receiving complex treatment with the inclusion of osteopathic methods, and the control group treated with conventional pharmacotherapy and diet therapy. The therapeutic effect was assessed using functional ultrasound examination of gallbladder motility, analysis of vegetative status according to the Kerdo index and psychoemotional state according to the WAM scale. The findings demonstrate that osteopathic treatment improves the gallbladder contractile function and promotes the normalization of vegetative balance. The osteopathy action mechanisms involve the correction of somatic dysfunctions of the internal organs, craniosacral system and spine, which contributes to the restoration of neurovegetative regulation and a decrease in the impact of stress factors on biliary motility. The absence of side effects confirms the safety and good tolerance of this approach. The findings highlight the promise of including osteopathic methods in the complex treatment of biliary dyskinesia, especially in patients with a pronounced psychoemotional component. Further multicenter studies with an enlarged sample size and long follow-up period, as well as the development of standardized osteopathic therapy protocols, are needed to confirm and expand the findings. The integration of multidisciplinary approaches combining osteopathic treatment, diet therapy and psychotherapeutic techniques appears to be a promising strategy for improving outcomes in functional biliary disorders.

The article presents clinical observations of the successful use of hirudotherapy and hijama (vacuum capillary bloodletting) as complementary methods in the treatment of patients with endometrial and cervical polyps. Any pathological process, including a benign neoplasm, occurs at the site of microcirculation disorders, capillaropathology, as a result of the impaired trophism and tissue regeneration, and accumulation of toxins. Due to the unique content of various biologically active substances in leech saliva, local and systemic lymph- and bloodletting by hijama, the body is cleansed, hormonal profile is restored, immunity is improved, and pathogenic microflora is destroyed.

The publication describes a practical example of treatment of a woman with the carpal tunnel syndrome. The article data details the procedure for manual examination of the patient and a set of therapeutic measures that demonstrate the effectiveness of manual techniques.

Background: Walking on uneven surfaces is a natural biomechanical challenge that stimulates neuromuscular adaptation, activates sensorimotor mechanisms and has rehabilitation applications. Despite growing interest in assessing adaptive responses, the effect of short-term exposure to uneven surfaces on gait parameters in healthy individuals remains understudied. Objective: To evaluate the immediate effect of short-term walking on an artificially uneven surface (step platforms) on gait biomechanics using a 2D video analysis. Materials and methods: Thirty-nine healthy volunteers (mean age: 29 years, height: 175 cm, weight: 78 kg) participated in the study and were randomly assigned to the main (n = 19) and control (n = 20) groups. All participants performed three stages of barefoot walking: (1) on a flat surface (baseline), (2) the main group – on an artificially uneven surface (step platforms), the control group – on a flat surface, (3) repeated walking on a flat surface. The biomechanical parameters (hip, knee, and ankle joint angles, step length, step time, speed) were assessed using a 2D video analysis (OpenPose, 240 fps). Statistical analysis was performed in StatTech v.4.8.5 code (Russia) using the Mann–Whitney U test (p<0,05). Results: Statistically significant differences in dominant frequency variance were observed in the main group at stages 2 and 3 (p < 0,001 and p = 0,002, respectively) compared to the control one. The main group showed an increase in the ankle dorsiflexion amplitude, knee flexion angle, step time and variability of movements after uneven surface walking which indicates the activation of sensorimotor adaptation mechanisms and the enhanced stability. Conclusion: Short-term walking on an artificially uneven surface induces immediate biomechanical adaptations which confirm diagnostic and rehabilitation potential of this type of exercise and the high sensitivity of a 2D video analysis for assessing adaptations.

Coxarthrosis (hip osteoarthritis) is a common degenerative-dystrophic disease with an increasing global prevalence which leads to persistent pain syndrome, impaired biomechanics and reduced quality of life. Traditional approaches, including pharmacotherapy and exercise therapy, often have limitations: drug treatment does not affect the progression of degeneration and carries the risk of side effects, and the effectiveness of physical therapy is limited by low patient adherence. In this regard, the study and integration of additional non-drug methods, such as osteopathy, into complex treatment seems relevant.

The article presents the first attempt to consider restless legs syndrome (RLS) from the point of view of systemic pathology of the nervous system that regards its pathogenesis as discordance between the program of movement formation within the central nervous system and the activity of peripheral structures that perform executive functions and constitute latent myofascial trigger point (MFTP) of the gastrocnemial muscles. The actual peripheral MFTP factor is a triggering and supporting link in the RLS pathogenesis. Pathologic changes in the lumbar spine and sacroiliac joints serve as mediators in modulating the spinal reflex hyperactivity and in reducing suprasegmental inhibitory mechanisms by forming generators of pathological hyperactivity in the rostral parts of the medulla at the level of synergies of the movement construction. Typical manifestations of the RLS are developed in conditions of minimal dysfunction of the mesodiencephalon - the formation of generators of pathological hyperactivity at different levels of the movement construction system. The treatment provides for the correction of pathological mechanisms at different levels such as peripheral, vertebral, and cerebral.

Treatment of chemical burns is a serious problem of modern science and practice. There was the first experience of using osteopathy for the diagnosis and treatment of skin burns. Materials and methods. A clinical case of a patient with a limited deep chemical burn of the finger is presented, in whicha combined method of treatment with the use of osteopathic technique was applied according to the severity of the process course. Clinical, osteopathic and analytical methods were applied. Treatment results. The mechanical method was able to separate the adhered scab (formed from the effects of a chemical reagent) and the underlying tissues of the finger, to ensure the outflow of purulent contents of the wound and diminution of intoxication syndrome, to achieve scarring of the burn wound. Conclusion. The use of the osteopathic technique allowed us to achieve the desired result - complete recovery of the patient.

Introduction: The musculoskeletal system of the human body and its anatomical units closely interact with each other. Despite the emergence of modern diagnostic methods in medicine, in particular in dentistry, the acceptance by doctors of the fact that patients are indicated for diagnosis of systemic disorders of the musculoskeletal system is mostly denied. Before proceeding with radical treatment, occlusal and postural disorders should be taken into account as the main etiological factors of TMJ dysfunction. Purpose: To study correlations between developmental anomalies of the mandibular ramuses and differential lower limb lengths in adult patients. Materials and methods: 136 patients with facial asymmetry and TMJ problems were diagnosed, and the correlation between the mandible ramus lengths and the parameters of the lower limbs and pelvis was analyzed. The following were used for diagnosis: radiography of the lower limbs, computerized optical assessment of posture topography using the DIERS Formetric 4D motion complex, cone-beam computed tomography (CBCT) of the joints. Results: According to the radiologist's report of 136 patients in the study group, anatomical shortening of one lower limb (ALLD - anatomical leg length discrepancy) was detected in 83 patients, which amounted to 61%. Of these, 31 (37.3%) patients had anatomical shortening of the right extremity, and in 52 (62.7%) cases the left extremity was shorter than the right one. According to the results of CBCT assessment of the patients, 89 patients showed predominance of the length of the left mandibular ramus, and 47 patients showed an increase in the length of the right ramus. Based on the results of quantitative evaluation of digital CBCT sections of the mandibular ramuses in patients of the study group, it was revealed that in 54 (65.1%) patients the left mandibular ramus was shorter than the right one, and in 29 (34.9%) cases the right mandibular ramus was shorter than the left one. According to the results of the postural DIERS Formetric analysis of all patients with ALLD, torsion and rotation of the pelvis were slightly expressed (from 0 to 2°), which confirms the representativeness of the sample. 31 (37.3%) patients had left pelvic tilt, and 52 (62.7%) had right pelvic tilt; this data correlates with X-ray findings. According to the results, shortening of the mandibular ramus and ALLD were observed on the same side of the body in 96.4% of cases. The remaining 3.6% of cases of the correlation discrepancy are related to the secondary acquired pathologies, injuries, and surgeries of the lower limbs. Conclusion: Based on the methods of modern evidence-based medicine, assessment of occlusal-postural disorders, we can conclude that there is a direct correlation between the lengths of the mandibular ramuses as well as the lower limb lengths in cases of anatomical differences in the length of the lower limbs. We conclude that shortening of the mandibular ramus and ALLD are observed on the same side of the body in most cases. This is due to the translation of the head towards to the long leg in order to maintain the vertical position and the static-dynamic balance of the body. We would like to note separately that the minimum parameters of pelvic torsion and rotation, as well as the pronounced values of the pelvic tilt (skew), directly determine the presence of anatomical shortening of the lower limb. The greater the pelvic tilt, the more pronounced are the deformities of the TMJ condyles and the shortening of one mandibular ramus.

The novelty of this study lies in the disclosure of features of the manual (osteopathic) approach in the treatment of thermal skin burns in patients in the acute period (1-3 days) of burn injury whichallow achieving the best quality of life of patients who have suffered from this serious pathology. Clinical, osteopathic, and analytical techniques were used. The study result: Combustiologists and osteopathy doctors work together to provide medical care to patients with skin burns in the acute period. The effectiveness of treatment is conditioned by organizational issues: timely and possibly more accurate and early diagnosis of burn severity, prompt start of pathogenetic treatment, use of modern achievements of medical science and practice including the use of osteopathic (manual) methods ofdiagnosis, treatment and rehabilitation.

The data of official statistics (Rosstat (Russian Statistics Agency)) related to“osteopathy” profile was studied; statistical and analytical methods were applied. The study result is that the state health care system represents only asmall part of the system of osteopathic services since “osteopathy” operates mainly in the non-state sector. The staff of osteopathic doctors in inpatient and outpatient conditions differs little. It is extremely scarce, with further negative staffing dynamics. The widespread use of osteopathic methods, like any other approach, should be preceded by a process of comprehensive evaluation of effectiveness from the standpoint of evidence-based medicine.

The article presents an analysis of the results of 30 randomized trials conducted from 2003 to 2023 on the use of osteopathic treatment for acute and chronic low back pain. It has been shown that osteopathic treatment for this pathology leads to a decrease in pain intensity and an improvement in the quality of life of patients. Pain severity has been demonstrated to correlate with the number of key osteopathic lesions, with direct implications for the use of osteopathic manual therapy (OMT) in patients. OMT can be used as a means to relieve pain in patients who do not use painkillers or to reduce their dose.

The article shows the changes in cerebrospinal fluid flow that occur in various pathologies, recorded by MRI images [4,5],using the anatomical model of the spinal cord and spinal nerve. These changes affect the dynamic parameters of cerebrospinal fluid outflow [2] and CO2 dissolved in it, lead to a decrease in gas exchange and cause the body to reduce its functional reserves.