Introduction. Muscular torticollis (MT) is the most common lesion of the musculoskeletal system in children, ranking third in pediatric practice. There are references in the literature confi rming high effi cacy of manipulative therapy, but in Cochrane′s 2015 Annual Review, experts did not fi nd evidence of the effectiveness of the manipulations. We carried out research in order to determine the effectiveness of osteopathic manipulative correction (OMC) in children with muscular torticollis (MT) due to birth injury (code for ICD X: P 15.8).Goal of research — to study the gradual effectiveness of OMC on the basis of clinical and instrumental studies and ultrasound examination of the relationship between the bone structures and the cervical muscles.Materials and methods. 57 children aged 0–7 years with muscular torticollis due to birth injury were examined. All patients were randomly divided into 2 groups. Patients of the main group (32 children) received osteopathic treatment. Each child received from 3 to 5 sessions, depending on the severity of the birth injury and the duration of postural disorders. The time gap between the sessions was 2–3 weeks. Patients of the control group (25 children) received physiotherapy, massage and orthosis every day for 2 weeks. Along with the neurological examination the study of the effectiveness of treatment included assessment of the pain syndrome with the use of the behavioral numerical scale FLACC, and the assessment of the muscle tone with the help of the kinesthetic examination. Angle of rotation in the cervical spine was measured with the use of the goniometer. Moreover, all children underwent sonography of the cervical spine in order to determine the position of the tooth axis, with the calculation of the coeffi cient of asymmetry. The state of the musculus rectus capitis major (MRCM) and musculus sterno cleido mastoideus (MSCM) was also assessed.Results. It was observed that after OMC the clinically signifi cant improvement started earlier in patients of the main group. This improvement manifested by complete elimination or signifi cant reduction of biomechanical and tone disorders in the neck. Pain syndrome, measured with the help of the FLACC scale, signifi cantly decreased both after treatment and in catamnesis after 6 months (p0,05). When intercomparing left and right muscles in the groups, signifi cant differences were revealed (p0,05).Conclusion. The use of OMC (3 to 5 treatment sessions with the intervals of 2–3 weeks) in patients with MT is more effective than the treatment with the use of physiotherapy, massage and orthotics, which was received by patients every day for 2 weeks. This allows to recommend OMC for wider clinical use in this category of patients.
Introduction. Myogenic torticollis is the most common injury in children′s musculoskeletal system. Atlantoaxial rotatory subluxation is one of the main reasons for this pathology. In the newborn even a minor injury during pathological delivery can cause this. The ultrasound method allows you to conduct a real time examination and provide the physician by complete information about the state of pulpal nucleus, fi brous ring, and relative position of cervical vertebrae bodies, spinal canal and radicular canals. Also it allows you to estimate neck muscles thickness and area, which is an informative complementary method of osteopathic diagnosis.Goal of research — clarifi cation of the criteria for biomechanical component of local and regional level somatic dysfunction by ultrasound examination of the cervical spine Materials and methods. The paper presents the data of cervical spine ultrasound examination for 57 nursing infants, infants and preschoolers with myogenic torticollis due to birth injury (ICD code X: P 15.8).Results. An ultrasound examination of the cervical spine determined the quantitative parameters of the atlantoaxial joint and the spinal canal, which was 17,57±0,44 mm. By posterior approach, the asymmetric position of the C II odontoid bone with respect to lateral masses of the atlas was determined; a statistically signifi cant width difference in atlantoaxial joint space was revealed (p<0,001). By muscles ultrasound examination, signifi cant thickness differences between left and right larger posterior straight muscles of the head (p<0,05) were found. Signs of instability at the CII–CIII level were detected in all patients, with no instability signs at other levels.Conclusion. The established criteria for ultrasound examination are atlantoaxial joint state, hypermobility of spinal motor segments, as well as muscles thickness and area in region under study. This allows us to verify instrumentally biomechanical SD of both local and regional levels, thus dynamic control over osteopathic treatment effectiveness is possible.
This analytical review present of the literature on rehabilitation of patients with non-specific low back pain. The wide occurrence of pathology determines the relevance of the studied problem. Much attention is paid to the complex approach, taking into account the pathogenetic mechanisms, the type of pain — nociceptive, neuropathic, dysfunctional, mixed, its temporary characteristics (acute, chronic pain), the emotional and somatic status of patients, pain attitudes and pain behaviors. The article considers a multidisciplinary approach to the treatment of patients with non-specific pain in the lower back using physical therapy modalities, balneology, medication and interventional treatment.
Introduction. In connection with the widespread introduction of osteopathy into practical medicine, new facts confi rming its effectiveness are appearing. These facts need theoretical justifi cation. The biodynamic approach is the least studied and scientifi cally proven approach in osteopathy. There are only a few works describing the benefi cial effects of this type of treatment on the autonomic nervous system based on an assessment of heart rate variability. One of the most sensitive indicators of changes in the state of the body is the electrical activity of the skin (EAS), which is widely used in modern polygraphic devices.Goal of research — to investigate the EAS in the physician and in the patient during the session of craniosacral biodynamics (CSB).Materials and methods. The study involved 32 patients who were randomly divided into 2 groups — control group (10 patients) and main group (22 patients). In the control group there were 8 women and 2 men aged from 20 to 65 years (mean age 42±20 years). In the main group, 16 women and 6 men aged from 18 to 68 years (mean age 40±16 years) were examined. Two professional certifi ed computerized polygraphs «Chris» were used, simultaneously recording the EAS values of the doctor and the patient. In the main group, the background indicators were recorded at the fi rst stage (10 minutes), then the procedure of the CSB, which lasted 20 minutes, was recordered. The control group was used only for registration of EAS. At the same time, patients were in the same conditions as in the main group.Results. During the CSB, the state of both the doctor (p<0,001) and the patient (p<0,001) has changed signifi cantly. At the same time, the tendency of changes in individual indicators of EAS in patients during treatment was logical. The altered state of the physician practically did not depend on its original level (p>0,05). However, there was a high relationship between the states of the doctor during contact and non-contact treatment (correlation coeffi cient 0,80, p<0,001). The patient′s initial condition had a moderate, statistically signifi cant relationship with his condition during the treatment (p<0,001). Since the beginning of the craniosacral biodynamics, the patient′s condition has hardly changed. At the same time, the contactless impact on the patient′s body was comparable with the contact effect (correlation coeffi cient 0,97, p<0,001). There was no signifi cant relationship between the states of the physician and the patient before the beginning of the treatment (correlation coeffi cient 0,18, p>0,05). However, in the process of craniosacral biodynamics, a statistically signifi cant relationship was formed between them with a correlation coeffi cient for non-contact exposure equal to 0,49 (p<0,01) and for contact exposure — 0,34 (p<0,05). Biodynamic treatment statistically signifi cantly improved the state of the autonomic nervous system.Conclusion. The study of the electrical activity of the skin in craniosacral biodynamics is a highly informative method, which allows to verify and quantify the changes occurring in the patient and in the physician during the treatment.
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