Objectification of regional biomechanical disorders in patients with dorsopathy of the cervical spine

Abstract

Introduction. In the general methodology of osteopathy over the past 10–15 years there have been significant changes associated with the transition from a purely local paradigm to a comprehensive assessment of osteopathic status. According to approved clinical guidelines, it is customary to distinguish somatic dysfunctions at three levels: global, regional and local. In this case, somatic dysfunction can be characterized from the perspective of biomechanical, hydrodynamic and neurodynamic disorders. The introduction of a new paradigm undoubtedly requires a number of studies that could confirm the validity of such a hierarchical division of somatic dysfunctions. One of the criteria for determining regional somatic dysfunctions is a significant limitation of mobility of the entire region. This suggests that the volume of active movements in regional and local somatic dysfunctions should differ. However, no one has previously studied this hypothesis, which predetermined the purpose of this study.The aim was to objectify biomechanical disorders in areas of regional somatic dysfunction in patients with dorsopathy of the cervical spine.Materials and methods. A comparative blind study was conducted from June 2020 to December 2021 on the basis of the Polyclinic № 1 of the Administration of the President of the RF and the specialized osteopathic clinic «Mokhov Institute of Osteopathy». We observed 58 patients aged 18 to 45 years with dorsopathy of the cervical spine, 24 men and 34 women. All patients had their osteopathic status assessed, the range of active movements in the cervical spine was measured, and the level of pain was measured. Based on the results of osteopathic diagnostics, the patients were divided into two groups: the main group – with regional biomechanical disorders in the neck region and the comparison group – with local somatic dysfunctions of individual spinal motion segments at the level of the cervical spine (CI–VII). There were 31 people in the main group (18 women and 13 men), and 19 people in the comparison group (10 women and 9 men). Assessment of osteopathic status and severity of pain syndrome was carried out by one specialist, and angularometry by another, who did not know which group the examined patient belonged to.Results. For patients with dorsopathy of the cervical spine, the most typical somatic dysfunctions are at the regional level: neck (structural component), thoracic (structural component), lumbar (structural component), pelvis (structural and visceral components), dura mater. The vast majority of the examined patients (84 %) had a combination of 2 or more regional biomechanical disorders. Patients with local and regional disorders did not differ in the severity of pain syndrome (p>0,05). This preliminary allows us to conclude that the severity of the pain syndrome does not allow us to judge the level of manifestation of somatic dysfunctions (local / regional). As a result of the study, statistically significant differences (p≤0,05) were identified between groups in the range of motion in the cervical region in the sagittal plane, which confirms the initial hypothesis about a more pronounced limitation of range of motion in patients with regional somatic dysfunctions of the neck region compared to local ones.Conclusion. The presence of regional biomechanical disorders at the neck level in patients with dorsopathy of the cervical spine is accompanied by a more significant limitation in the range of active movements in the sagittal plane compared to patients with local disorders at this level. At the same time, the severity of the pain syndrome does not depend on the level of manifestation of somatic dysfunctions.