Randomized controlled study of the effectiveness of osteopathic manipulative correction for muscular torticollis due to birth injury

Abstract

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.