The use of osteopathic correction in the treatment of patients with sciatic neuropathy

Abstract

Introduction. In recent years, the interest of the medical community in peripheral neuropathies has significantly increased and great progress has been achieved in studying certain issues of etiopathogenesis and treatment of these conditions. The basis of therapy for piriformis syndrome (PS), as a particular form of sciatic neuropathy, is still drug therapy, but its use does not always lead to the desired results. This dictates the need to search for new, primarily non-drug, therapies as a part of the cumulative treatment of this disease. Previous work has demonstrated the possibilities of using reflexology, physiotherapy in the treatment of PS. Manual therapy has also been successfully used for a long time in the treatment of patients with this nosology, but most often only in the form of local approaches. In the available literature, there were no works evaluating the possibilities of using personalized osteopathic correction in this group of patients, as well as objectification of the complex treatment performed using ultrasound scanning. All of the above has predetermined the purpose of our research.   The aim of the study was to study the results of complex therapy of patients with sciatic neuropathy (SP) with the inclusion of osteopathic correction.   Materials and methods. A controlled randomized trial was conducted in the period from November 2020 to January 2022 on the basis of the profile medical clinic of LLC «Mokhov Institute of Osteopathy». We observed 22 patients aged 18 to 44 years with a diagnosis of sciatic neuropathy. Depending on the treatment used, all the observed patients were divided into the main (11 people) and control (11 people) groups using the simple randomization method. Patients of both groups received pharmacotherapy, and patients of the main group additionally underwent osteopathic correction (3 sessions with an interval of 8–10 days). All patients were assessed for osteopathic status, severity of pain syndrome and ultrasound diagnostics with assessment of the condition of the involved sciatic nerve. Evaluation and measurements were carried out before the start of treatment and 30 days after its start.   Results. In patients with sciatic neuropathy, regional biomechanical disorders of the regions were most often detected: pelvis, structural and visceral components (45,5 % and 68,2 % respectively), dura mater (59,1 %), lumbar, visceral component (45,5 %). Among the local somatic dysfunctions (DM), the dysfunction of individual vertebral-motor segments was most often determined at the level of the cervical (18,2 %), thoracic (18,2 %) and lumbar (22,7 %) spine, individual joints of the lower extremities (22,7 %), individual skull sutures (27,3 %). After treatment, only in patients of the main group, a statistically significant (p<0,05) decrease in the frequency of detection of regional biomechanical disorders of the pelvic region (structural and visceral component), TMO was obtained. For the rest of the SD, the differences were not significant. The examined patients were characterized by moderate pain syndrome. The therapy, both with and without osteopathic correction, has shown good results. In patients of both groups, there was a significant (p < 0,05) decrease in the intensity of pain syndrome, but in the main group these changes were significantly more pronounced. Patients with sciatic neuropathy were characterized by an increased thickness of the nerve and a decrease in its echogenicity according to the results of ultrasound diagnostics. Against the background of therapy, patients of both groups have a decrease in nerve thickness, but in the main group these changes were statistically significant (p < 0,05) more pronounced. But normalization of nerve echogenicity was observed only in patients of the main group who received osteopathic correction (significant changes, p < 0,05).   Conclusion. The use of osteopathic correction in the framework of complex therapy of patients with sciatic neuropathy allows to achieve a statistically more significant reduction in the intensity of pain syndrome and normalization of nerve structure (according to ultrasound data) compared with the isolated use of drug therapy. It is advisable to continue the study on a larger sample of patients.