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Background: Health professionals develop their own approach to patient care based on education, experience and philosophical stance. Literature suggests that this practice approach informs patient care, and clinical outcomes. The Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The aim of the study was to develop evidence for the structural and construct validity of the Osteo-TAQ in the Australian osteopathic profession and provide initial descriptive data about the therapeutic approaches of osteopaths in Australia. Methods: A cross-sectional study design was used to collect data from registered osteopaths in Australia using the Osteo-TAQ and analysed with Exploratory Factor Analysis (EFA). The EFA utilised parallel analysis to determine the number of factors to extract and McDonald's omega calculated as the reliability estimation statistic. Results: 691 Australian osteopaths provided data for the study, representing 25% of the Australian osteopathic profession. Empirically the number of factors to extract based on the parallel analysis was seven. Two- and three-factor solutions were evaluated given the underpinning theory identifying two conceptions of practice and three interrelated therapeutic approaches. Both the two- and three-factor solutions were consistent with the underpinning theory with acceptable reliability estimations for each factor. Descriptive data suggested the most common element of the therapeutic approach of Australian osteopaths was establishing rapport, while the least common was 'only talking' with their patients. Conclusions: This study provides evidence for the structural, content and construct validity of the Osteo-TAQ in an Australian osteopathic practitioner population. The results support both a two- and three-factor structure for the Osteo-TAQ in an Australian osteopathic population, with each factor demonstrating acceptable reliability estimations supporting the items comprising each factor as measuring a single construct. From a theoretical and empirical perspective, it can be inferred that the Osteo-TAQ tool encapsulates an osteopaths' conception of practice (professional artistry and technical rational) and three main therapeutic approaches to patient care: Educator, Communicator and Treater. Further research is required to explore each of these therapeutic approaches to better understand how they relate to an individual osteopath's conception of practice, and their associations with other measures of practice including clinical outcomes. [ABSTRACT FROM AUTHOR]

Background/Objective: Short hamstring syndrome is common in the general population and can lead to impaired balance, function, and posture, and increased risk of injuries. Local treatments have obtained controversial results, so it is necessary to evaluate the effectiveness of other types of therapy such as osteopathic treatment. To evaluate the efficacy of osteopathic techniques in increasing the elasticity of the hamstring musculature in short hamstring syndrome. Methods: A systematic review of randomised controlled trials was conducted in PubMed, Medline, Cinhal, Scopus, WOS, SPORTDiscuss, and PEDro. The PEDro scale was used to evaluate the methodological quality and the RoB2 for the evaluation of biases. Results: A total of eight articles were selected. Most of the participants were assessed with the Active Knee Extension or Straight Leg Raise tests. The osteopathic techniques used were the muscle energy technique, suboccipital inhibition, and vertebral mobilisations. As for the control interventions, they mainly included passive stretching and placebo. Conclusions: The results suggest that osteopathic techniques are more effective than placebo or other interventions in increasing flexibility in adult patients with short hamstring syndrome. This effect can be explained by neurophysiological (Golgi apparatus, neuromuscular spindle activity, and Hoffmann reflex) and structural factors (dura mater, posture, and myofascial chains). Nevertheless, the evidence suggests that it would be beneficial to incorporate this type of treatment into flexibility improvement programmes. [ABSTRACT FROM AUTHOR]

Osteopathy is a complementary treatment method that targets motor restrictions and enhances motility through touch. While recent studies have explored the functions, dimensions, and effects of touch in osteopathy, there is a lack of research on how touch renders bodies intelligible – or what bodies, for that matter. In this article, we use the verb to affect/to be affected to explore how bodies become known by and to Dutch osteopaths, and how the senses play a role in this. Our analysis shows how touch allows osteopaths to affect and be affected by their patients’ bodies – as well as by their own. [ABSTRACT FROM AUTHOR]

Background: Spinal manipulation (SM) has been claimed to change anatomy, either in structure or position, and that these changes may be the cause of clinical improvements. The aim of this systematic review was to evaluate and synthesise the peer-reviewed literature on the current evidence of anatomical changes in response to SM. Methods: The review was registered with PROSPERO (CRD42022304971) and reporting was guided by the standards of the PRISMA Statement. We searched Medline, Embase, CINAHL, AMED, Cochrane Library all databases, PEDro, and the Index to Chiropractic Literature from inception to 11 March 2022 and updated on 06 June 2023. Search terms included manipulation, adjustment, chiropractic, osteopathy, spine and spine-related structures. We included primary research studies that compared outcomes with and without SM regardless of study design. Manipulation was defined as high-velocity, low-amplitude thrust delivered by hand to the spine or directly related joints. Included studies objectively measured a potential change in an anatomical structure or in position. We developed a novel list of methodological quality items in addition to a short, customized list of risk of bias (RoB) items. We used quality and RoB items together to determine whether an article was credible or not credible. We sought differences in outcomes between SM and control groups for randomised controlled trials and crossover studies, and between pre- and post-SM outcomes for other study designs. We reported, in narrative form, whether there was a change or not. Results: The search retrieved 19,572 articles and 20 of those were included for review. Study topics included vertebral position (n = 3) facet joint space (n = 5), spinal stiffness (n = 3), resting muscle thickness (n = 6), intervertebral disc pressure (n = 1), myofascial hysteresis (n = 1), and further damage to already damaged arteries (n = 1). Eight articles were considered credible. The credible articles indicated that lumbar facet joint space increased and spinal stiffness decreased but that the resting muscle thickness did not change. Conclusion: We found few studies on this topic. However, there are two promising areas for future study: facet joint space and spinal stiffness. A research strategy should be developed with funding for high quality research centres. [ABSTRACT FROM AUTHOR]

Background: Positional plagiocephaly is an asymmetrical flattened skull deformity whose incidence increased significantly in the last decades. Osteopathic treatment has been suggested to tackle early deformational sequences, in order to ensure the correct development of the child. The aim of the study was to assess the effectiveness of osteopathic treatment of positional cranial deformities in infants. Methods: Retrospective observational study carried out at the Section of Neonatology and Neonatal Intensive Care Unit of the Department of Interdisciplinary Medicine of University of Bari, Italy in collaboration with a specialized pediatric osteopath. Results: 424 infants were enrolled. Isolated positional plagiocephaly affected the vast majority of infants (n. 390, 91.98%); 34 patients (8.02%) were diagnosed with positional brachycephaly. Both infant groups (positional plagiocephaly and positional brachycephaly) had a median severity score of 3 (IQR: 3 – 3 and 2 – 3, respectively) and benefited from a median of 3 osteopathic sessions (IQR 3–4 and 2–4, respectively). Higher severity scores of positional asymmetries were significantly more common in preterm neonates (Pearson chi2: 11.58; p-value: 0.021) and in males (Pearson chi2: 10.06; p-value: 0.039). Conclusions: Significant improvements in positional cranial deformations of children were obtained after only five osteopathic treatments provided in the first months of life. The osteopathic treatment could positively impact the clinical history of patients with positional plagiocephaly and positional brachycephaly. Implication for practice: • Positional plagiocephaly is increasingly common among infants and may cause moderate to severe neurodevelopmental adverse effects. • Osteopathic treatment may tackle early deformational sequences, in order to ensure the correct development of the child. • Our study reveals that cranial asymmetry of infants with positional plagiocephaly is significantly reduced after only five osteopathic treatments provided in the first months of life. • Osteopathic treatment should be offered as a first line approach to young infants diagnosed with positional plagiocephaly. [ABSTRACT FROM AUTHOR]

Background/Objectives: In osteopathy, it becomes necessary to produce high-quality evidence to demonstrate its effectiveness. The aim of this meta-research study is to assess the reporting quality of RCTs published in the osteopathic field. Methods: The protocol was preliminarily registered on the "Open Science Framework (OSF)" website. For reporting, we considered the PRISMA 2020 checklist. We included all the RCTs, published between 2011 and 2023, investigating the effectiveness of Osteopathic Manipulative Treatment (OMT) in any possible condition. The search process was conducted on four major biomedical databases including PubMed, Central, Scopus and Embase. A data extraction form was implemented to collect all relevant information. The completeness of reporting was calculated as the percentage of adherence to the CONSORT checklist; the Cochrane ROB 2 tool was considered to assess the risk of bias (RoB) in the following five major domains: randomization (D1), interventions (D2), missing data (D3), outcome measurement (D4), selective reporting (D5). Results: A total of 131 studies were included and the overall adherence was 57%, with the worst section being "other information" (42%). Studies with a lower RoB showed higher adherence to the CONSORT. The "results" section presented the highest differences as follows: D1 (−36.7%), D2 (−27.2%), D3 (−21.5%) and D5 (−25.5%). Significant correlations were also found between the preliminary protocol registration, higher journal quartile, publication in hybrid journals and the completeness of reporting (β: 19.22, CI: 14.45–24.00, p < 0.001; β: 5.41; CI: 2.80–8.02, p ≤ 0.001; β: 5.64, CI: 1.06–10.23, p = 0.016, respectively). Conclusions: The adherence to the CONSORT checklist in osteopathic RCTs is lacking. An association was found between a lower completeness of reporting and a higher RoB, a good journal ranking, publication in hybrid journals and a prospective protocol registration. Journals and authors should adopt all the strategies to adhere to reporting guidelines to guarantee generalization of the results arising from RCTs. [ABSTRACT FROM AUTHOR]

Abstract Background Health professionals develop their own approach to patient care based on education, experience and philosophical stance. Literature suggests that this practice approach informs patient care, and clinical outcomes. The Osteopaths’ Therapeutic Approaches Questionnaire (Osteo-TAQ) is a novel 36-item instrument developed from qualitative grounded theory research with osteopaths in the United Kingdom. The aim of the study was to develop evidence for the structural and construct validity of the Osteo-TAQ in the Australian osteopathic profession and provide initial descriptive data about the therapeutic approaches of osteopaths in Australia. Methods A cross-sectional study design was used to collect data from registered osteopaths in Australia using the Osteo-TAQ and analysed with Exploratory Factor Analysis (EFA). The EFA utilised parallel analysis to determine the number of factors to extract and McDonald’s omega calculated as the reliability estimation statistic. Results 691 Australian osteopaths provided data for the study, representing 25% of the Australian osteopathic profession. Empirically the number of factors to extract based on the parallel analysis was seven. Two- and three-factor solutions were evaluated given the underpinning theory identifying two conceptions of practice and three interrelated therapeutic approaches. Both the two- and three-factor solutions were consistent with the underpinning theory with acceptable reliability estimations for each factor. Descriptive data suggested the most common element of the therapeutic approach of Australian osteopaths was establishing rapport, while the least common was ‘only talking’ with their patients. Conclusions This study provides evidence for the structural, content and construct validity of the Osteo-TAQ in an Australian osteopathic practitioner population. The results support both a two- and three-factor structure for the Osteo-TAQ in an Australian osteopathic population, with each factor demonstrating acceptable reliability estimations supporting the items comprising each factor as measuring a single construct. From a theoretical and empirical perspective, it can be inferred that the Osteo-TAQ tool encapsulates an osteopaths’ conception of practice (professional artistry and technical rational) and three main therapeutic approaches to patient care: Educator, Communicator and Treater. Further research is required to explore each of these therapeutic approaches to better understand how they relate to an individual osteopath’s conception of practice, and their associations with other measures of practice including clinical outcomes.

Abstract Background Spinal manipulation (SM) has been claimed to change anatomy, either in structure or position, and that these changes may be the cause of clinical improvements. The aim of this systematic review was to evaluate and synthesise the peer-reviewed literature on the current evidence of anatomical changes in response to SM. Methods The review was registered with PROSPERO (CRD42022304971) and reporting was guided by the standards of the PRISMA Statement. We searched Medline, Embase, CINAHL, AMED, Cochrane Library all databases, PEDro, and the Index to Chiropractic Literature from inception to 11 March 2022 and updated on 06 June 2023. Search terms included manipulation, adjustment, chiropractic, osteopathy, spine and spine-related structures. We included primary research studies that compared outcomes with and without SM regardless of study design. Manipulation was defined as high-velocity, low-amplitude thrust delivered by hand to the spine or directly related joints. Included studies objectively measured a potential change in an anatomical structure or in position. We developed a novel list of methodological quality items in addition to a short, customized list of risk of bias (RoB) items. We used quality and RoB items together to determine whether an article was credible or not credible. We sought differences in outcomes between SM and control groups for randomised controlled trials and crossover studies, and between pre- and post-SM outcomes for other study designs. We reported, in narrative form, whether there was a change or not. Results The search retrieved 19,572 articles and 20 of those were included for review. Study topics included vertebral position (n = 3) facet joint space (n = 5), spinal stiffness (n = 3), resting muscle thickness (n = 6), intervertebral disc pressure (n = 1), myofascial hysteresis (n = 1), and further damage to already damaged arteries (n = 1). Eight articles were considered credible. The credible articles indicated that lumbar facet joint space increased and spinal stiffness decreased but that the resting muscle thickness did not change. Conclusion We found few studies on this topic. However, there are two promising areas for future study: facet joint space and spinal stiffness. A research strategy should be developed with funding for high quality research centres.

Abstract Background Positional plagiocephaly is an asymmetrical flattened skull deformity whose incidence increased significantly in the last decades. Osteopathic treatment has been suggested to tackle early deformational sequences, in order to ensure the correct development of the child. The aim of the study was to assess the effectiveness of osteopathic treatment of positional cranial deformities in infants. Methods Retrospective observational study carried out at the Section of Neonatology and Neonatal Intensive Care Unit of the Department of Interdisciplinary Medicine of University of Bari, Italy in collaboration with a specialized pediatric osteopath. Results 424 infants were enrolled. Isolated positional plagiocephaly affected the vast majority of infants (n. 390, 91.98%); 34 patients (8.02%) were diagnosed with positional brachycephaly. Both infant groups (positional plagiocephaly and positional brachycephaly) had a median severity score of 3 (IQR: 3 – 3 and 2 – 3, respectively) and benefited from a median of 3 osteopathic sessions (IQR 3–4 and 2–4, respectively). Higher severity scores of positional asymmetries were significantly more common in preterm neonates (Pearson chi2: 11.58; p-value: 0.021) and in males (Pearson chi2: 10.06; p-value: 0.039). Conclusions Significant improvements in positional cranial deformations of children were obtained after only five osteopathic treatments provided in the first months of life. The osteopathic treatment could positively impact the clinical history of patients with positional plagiocephaly and positional brachycephaly. Implication for practice • Positional plagiocephaly is increasingly common among infants and may cause moderate to severe neurodevelopmental adverse effects. • Osteopathic treatment may tackle early deformational sequences, in order to ensure the correct development of the child. • Our study reveals that cranial asymmetry of infants with positional plagiocephaly is significantly reduced after only five osteopathic treatments provided in the first months of life. • Osteopathic treatment should be offered as a first line approach to young infants diagnosed with positional plagiocephaly.

Background: Ankle fractures, comprising about 10% of musculoskeletal injuries, pose a significant healthcare burden with an increasing incidence, particularly among an aging population. This study focuses on isolated Danis-Weber type B fractures. Recent trends lean towards surgical intervention for anatomical restoration and quicker recovery, albeit with associated complications. This report aims to assess the safety and efficacy of the NewClip narrow locking plate system with early weight-bearing in treating isolated fibular fractures. Methods: The study includes patients with Danis-Weber type B fractures surgically treated with the NewClip narrow locking plate system. Exclusions involved nondisplaced fractures, open fractures, or those requiring additional fixation. Results: Fifteen patients were enrolled in this study. Minor complications, including wound swelling, were observed in two cases. The Visual Analogue Scale (VAS) for pain exhibited a steady decline postoperatively, with almost complete resolution by the third month. At three months, the FAOS demonstrated excellent results, and a final follow-up at twelve months revealed complete osseous healing without complications. Conclusions: The use of this type of plate in treating isolated fibular fractures with early weight-bearing shows promising results in terms of fracture healing, pain resolution, and functional outcomes, warranting further investigation with larger cohorts.

This paper aims to review the various surgical techniques for gastrocnemius–soleus recession and Achilles tendon lengthening, with a special focus on the treatment of clubfoot and cerebral palsy (CP) equinus contracture. This descriptive review article comprehensively explores different techniques for gastrocnemius recession, including the Hoke percutaneous triple hemisection, Baker’s method (Tongue-in-Groove Gastrocnemius–Soleus Recession), the Vulpius method, the Baumann procedure, and the Strayer procedure (Gastrocnemius Recession). The objective is to present a detailed analysis of these methods, covering their indications, procedural nuances, relevance in clinical practice, and outcomes.

Advanced laboratory methods play a crucial role in bone research, allowing researchers and scientists to study the complex biology and nature of the skeleton. Dual-energy X-ray absorptiometry (DXA) is a non-invasive method of measuring bone mass, which is an important parameter for the diagnosis and treatment of several bone diseases. Micro-computed tomography (μCT) is a very high-resolution technique that can be used to investigate the 3D microstructure of trabecular bone. Dynamic bone histomorphometry is used to assess histological indices of bone formation and resorption using fluorochromes embedded into newly formed bone. Mechanical testing is used to measure bone strength and stiffness, providing important information about bone quality and fracture risk. All these methods are widely used in preclinical in vivo studies using rodents and in most clinical studies. Therefore, it is important for both researchers and scientists within the field of bone biology, and those in neighboring fields, to be familiar with their use, strengths, limitations, and important technical aspects. Several guidelines and protocols about the topic have been published, but are very exhaustive. The present review aimed to provide instructions for early-career researchers and outline important concepts and technical aspects of DXA, μCT, dynamic bone histomorphometry, and mechanical testing in bone research.

Weight-bearing physical activity is considered beneficial to bone health throughout the course of life, with the most marked benefits for bone health often considered to be high levels of activity around the time of peak bone mass (PBM) acquisition. To date, the research focus has been on the benefits of recreational weight-bearing sporting activity. Participation in elite sport is associated with enhanced sporting activity but is often also associated with low body weight, menstrual disturbance in females, and rest periods following injury. The benefit of sporting activity may, therefore, be attenuated in these groups. Here, we undertook a systematic review to consider what evidence is available regarding whether elite sporting activity in young adulthood has lasting benefits for bone health. Studies of retired athletes aged >50 years, who participated in elite sport from 15 to 30 years, were considered for inclusion. Elite sport was defined as participation at the national level or above. Following protocol development, the search strategy was applied to PubMed, Medline, Embase, and Web of Science. The selection was managed with Rayyan software, and the bias was assessed using the Newcastle–Ottawa scale. Two reviewers independently identified papers; a third adjudicated and screened the final selection for consideration. The protocol was registered with PROSPERO (CRD42021293644). Two reviewers screened 951 articles, of which 4 papers met the inclusion criteria. One paper reported findings in women and three in men; no paper included both sexes. The sample sizes varied from 24 to 193 and considered football, endurance running, weightlifting, and swimming. Bone density was measured at the femoral neck, trochanter, and lumbar spine. All studies reported higher density in former athletes than non-elite controls, though the information available regarding confounding lifestyle factors was variable. A meta-analysis was not possible as studies were too heterogenous. In conclusion, from the limited available evidence, our study suggests elite sporting activity in young adulthood may have lasting benefits for bone health. However, given the paucity of available data, we highlight an urgent need for future research, especially in female athletes.

Evaluation of the 3D bone morphology of the glenohumeral joint is necessary for pre-surgical planning. Zero echo time (ZTE) magnetic resonance imaging (MRI) provides excellent bone contrast and can potentially be used in the place of computed tomography. Segmentation of the shoulder anatomy, particularly the humeral head and the acetabulum, is needed for the detailed assessment of each anatomy and for pre-surgical preparation. In this study, we compared the performance of two popular deep learning models based on Google’s DeepLab and U-Net to perform automated segmentation on ZTE MRI of human shoulders. Axial ZTE images of normal shoulders (n = 31) acquired at 3-Tesla were annotated for training with DeepLab and 2D U-Net, and the trained model was validated with testing data (n = 13). While both models showed visually satisfactory results for segmenting the humeral bone, U-Net slightly over-estimated while DeepLab under-estimated the segmented area compared to the ground truth. Testing accuracy quantified by Dice score was significantly higher (p < 0.05) for U-Net (88%) than DeepLab (81%) for the humeral segmentation. We have also implemented the U-Net model onto an MRI console for push-button DL segmentation processing. Although this is an early work with limitations, our approach has the potential to improve shoulder MR evaluation hindered by manual post-processing and may provide clinical benefit for quickly visualizing bones of the glenohumeral joint.

Religion and spirituality (R/S) play a significant role in the way many individuals make decisions and structure their lives. The purpose of this exploratory study was to assess the attitudes and preferences of individuals who live or worship in Camden County, NJ, in regards to physicians addressing their religious and spiritual beliefs during medical care. This study was conducted through a survey which inquired about the level of the participant's religiosity/spirituality, specific religion, and attitudes towards and desires for conversations regarding religious and spiritual beliefs during medical care. Many survey participants shared strong opinions about physicians addressing R/S beliefs during medical encounters, with the majority expressing a positive view of conversations about R/S in medical care. The majority of respondents (75%) reported holding religious or spiritual beliefs that they described as important or very important to them, while 60% of participants indicated that their physician's awareness of their R/S beliefs was at least somewhat important to them. Based on the results of this exploratory study, the recommendation of the AAMC and Joint Commission to include conversations about R/S in medical care, as well as the tenets of osteopathic philosophy are consistent with the majority opinion about R/S in medical care that was expressed through this survey. [ABSTRACT FROM AUTHOR]

Background. At the end of a long definition and legislative process (Law No.3 of 11 January 2018 and DPR No 131 of 2021), started under the thrust of the European directives, with the Decree of the Ministry of Universities and Research of 29 November 2023, in agreement with the Minister of Health, osteopathy in Italy has become a healthcare profession in all respects. Materials and Methods. In order to understand the current legislative and professional position of the Osteopath, research of the original definitions and the history of the profession has been carried out, assessing an overview of the current situations among EU countries. Therefore, an analysis of the current Italian legislation has been carried out in a medical-legal key, with a critical eye aimed above all at assessing the current shortcomings. Conclusions. the inclusion of osteopathy as a healthcare profession in Italy is a significant step towards the regulation and recognition of this practice, implying considerable innovations both in terms of access to the profession, both in the field of the professional health responsibility. Even if with the Decree of 29 November 2023, a significant step forward has been made, further regulatory and control measures are needed to ensure the quality, safety, and effectiveness of osteopathic treatments, as well as the protection of patients and the professionalism of operators. [ABSTRACT FROM AUTHOR]

Ausgehend von verschiedenen internationalen und nationalen historischen Ereignissen und einer fehlenden Identität der Osteopathie besteht in Deutschland eine Undifferenziertheit zwischen Manualmedizin und Osteopathie. In einem ersten Schritt besteht daher die Notwendigkeit einer eindeutigen Definition der Osteopathie. Da diese nur aus Teilbereichen hergeleitet werden kann, wurde der subjektiv-aktive Bereich der Technikausführung zum Gegenstand dieser Untersuchung ausgewählt. Somit lautet das Ziel: Gemeinsamkeiten und Unterschiede des subjektiv-aktiven Aspektes während der Technikausführung zwischen Osteopathen*innen und Manualmediziner*innen herauszufinden. Zur Bearbeitung wurde eine zweistufige Methodik genutzt; beginnend mit einer qualitativen Inhaltsanalyse des Still-Kompendiums, gefolgt von Experteninterviews, die ebenso qualitativ ausgewertet wurden. Aus der qualitativen Inhaltsanalyse des Still-Kompendiums kann für den subjektiv-aktiven Aspekt geschlossen werden, dass der/die Osteopath*in während einer Technikausführung wie ein/e Mechaniker*in denkt – wobei dieser Terminus im biografisch-soziokulturellen Kontext eines A.T. Still zu verstehen ist – und somit auf Grundlage tiefgreifender und umfassender Anatomiekenntnisse ein klares Bild des normalen Körpers im Geist präsent hat. Aus den Expert*inneninterviews ergab sich, dass die subjektiv-aktive Komponente vor allem im Kontext der holistischen Betrachtungsweise des Patienten bzw. der Patientin sowie eines konzentrierten Fühlens während der osteopathischen Technikausführung eine Heterogenität zwischen den beiden untersuchten Disziplinen aufweist. Gemeinsam hingegen sind der respektvolle Umgang mit den Patient*innen, die Art bzw. Methodik der Technik sowie die neuroreflektorischen Zusammenhänge, auf denen die Behandlung beruht. Based on various international and national historical events and a lack of identity of osteopathy, there is an indistinction between manual medicine and osteopathy in Germany. As a first step, there is a need for a clear definition of osteopathy. Since this can only be derived from partial areas, the subjective-active area of technique execution was chosen as the object of investigation for this study. Thus, the aim is: to find similarities and differences of the subjective-active aspect during the execution of the technique between osteopaths and manual physicians. A two-stage methodology was used, starting with a qualitative content analysis of the Still Compendium, followed by four expert interviews, which were analysed qualitatively as well. From the qualitative content analysis of the Still Compendium it can be concluded for the subjective-active aspect that the osteopath thinks like a mechanic during a technique execution – whereby this term is to be understood in the biographical-sociocultural context of A.T. Still – and thus has a clear picture of the normal body present in his or her mind based on profound and comprehensive knowledge of anatomy. The expert interviews revealed that the subjective-active component shows heterogeneity between the two disciplines studied, especially in the context of the holistic approach to the patient as well as a concentrated feeling while executing the osteopathic technique. In contrast, the respectful treatment of the patient, the type and methodology of the technique and the neuroreflective connections on which the treatment is based are common. [ABSTRACT FROM AUTHOR]

Objetivo: evaluar los efectos del uso de plasma rico en plaquetas (PRP), ácido hialurónico (AH), o su combinación, en la analgesia y funcionalidad en pacientes femeninas operadas por artroscopía por lesiones condrales en la rodilla. Materiales y métodos: estudio de cohorte prospectivo, participaron dieciséis pacientes femeninas con una edad promedio de 52.7 años (DE = 2.84). Las exposiciones evaluadas fueron inyección intraarticular de plasma rico en plaquetas (12.5%), ácido hialurónico (37.5%) y su combinación (50.0%). Todas las pacientes fueron seguidas durante cuatro semanas postquirúrgicas. Se evaluaron el dolor, la funcionalidad en términos de distancia caminada y capacidad para subir y bajar escaleras, y los resultados de maniobras clínicas (Appley, McMurray, cajón anterior y posterior). Resultados: se observó que el dolor promedio disminuyó significativamente de 3 (DE = 1) a 2 (DE = 1) (p = 0.015). En la escala funcional de subir y bajar escaleras, se constató una mejoría clínica significativa (p = 0.004), con un aumento del 12.5% al 62.5% en las pacientes que realizaban esta actividad sin asistencia. Las maniobras de Appley y McMurray positivas al dolor mostraron disminución, siendo significativa la segunda (p = 0.072 y p = 0.023). Conclusiones: a la fecha, la evidencia que apoya o rechaza la inyección de ortobiológicos es escasa y controversial. Los resultados de este estudio sugieren que estas intervenciones pueden ser efectivas para la rehabilitación postquirúrgica en pacientes con lesiones condrales en la rodilla, aunque se necesitan trabajos con mayores muestras y seguimiento a largo plazo para reforzar estos hallazgos.

Introducción: convencionalmente, la reconstrucción del LCA ha sido tratada mediante diversas reconstrucciones con injertos, como el tendón rotuliano (H-T-H), el tendón semitendinoso recto interno del músculo isquiotibial (ST-RI), el tendón cuadricipital (TC) o, en algunas ocasiones, con aloinjertos (Alo), entre otros. Sin embargo, todos estos injertos están asociados con algunas complicaciones. El uso del tendón peroneo lateral largo (PLL) fue descripto por primera vez por Kerimoğlu et al. en 2008 y los resultados comparativos funcionales de trabajos en revistas científicas recientes lo posicionan como una alternativa válida para la reconstrucción del LCA, ya que proporcionó mejores resultados clínicos en la rodilla, aunque con una puntuación ligeramente inferior en el score AOFAS en comparación con el preoperatorio. Objetivo: reportar nuestra experiencia inicial usando el tendón peroneo lateral largo (PLL) como alternativa en las reconstrucciones del ligamento cruzado anterior (LCA), evaluando la morbilidad del sitio donante. Materiales y métodos: entre junio de 2023 y julio de 2024 se realizaron veintinueve reconstrucciones de LCA utilizando injerto del tendón PLL como injerto de elección. Los criterios de inclusión para evaluar la morbilidad del sitio donante fueron haber cumplido tres meses postoperatorios. Se excluyeron pacientes con inestabilidad crónica de tobillo o pie plano en el lado intervenido. Para la evaluación de la morbilidad del sitio dador se utilizó el score AOFAS y el score de FADI. Resultados: diecisiete pacientes cumplieron con el criterio de inclusión (seguimiento mayor a tres meses). El score AOFAS promedio a los tres meses fue de 92.25 ± 5.18, y el score FADI fue de 94.37 ± 4.18, sin diferencias significativas entre revisiones y plásticas primarias, ni entre sexos. Conclusión: en el presente trabajo, los resultados clínicos obtenidos son similares a los de la literatura actual en la evaluación a los tres meses postquirúrgicos utilizando el PLL para la reconstrucción del LCA. Al existir una baja morbilidad del sitio donante y con resultados funcionales similares a los autoinjertos habituales a largo plazo, podríamos considerarlo como una opción válida, en particular en casos de revisión donde la plástica primaria se realizó utilizando injertos alrededor de la rodilla. Los resultados a mediano y largo plazo se encuentran en estudio.

Introducción: luego de una reconstrucción primaria de LCA, la infección es una complicación poco frecuente que puede conducir a resultados devastadores. En pos de una solución, hace una década se comenzó a remojar el injerto en vancomicina. Objetivo: determinar si la sumersión previa del injerto de isquiotibiales autólogos en vancomicina reduce la tasa de infección en la reconstrucción primaria de LCA. Materiales y métodos: análisis retrospectivo multicéntrico en el que se incluyeron seiscientas veintiséis reconstrucciones primarias de LCA en un período comprendido entre julio de 2013 a marzo de 2020: cuatrocientos veintitrés pacientes fueron tratados con la profilaxis antibiótica endovenosa clásica (Grupo 1) y doscientos tres pacientes con la sumersión del injerto en una solución de 5 mg/ml de vancomicina sumado a la profilaxis antibiótica endovenosa (Grupo 2). Resultados: se observaron seis casos de artritis séptica en el Grupo 1 (1.41%): tres por Staphylococcus aureus, un Staphylococcus epidermidis y otro por Pseudomonas aeruginosa. El Grupo 2 no reportó casos de infección. Conclusión: en esta serie, la sumersión profiláctica del injerto de isquiotibiales redujo la tasa de infección en comparación con los antibióticos endovenosos solos.

Introducción: las almohadillas de grasa peripatelares en la cinemática normal de la rodilla son un elemento fundamental. La rótula alta es uno de los factores etiológicos más importantes de la inestabilidad femororrotuliana y se considera predisponente para el desarrollo del dolor femororrotuliano. El objetivo de este trabajo es demostrar los hallazgos en resonancia magnética del compromiso del sector superolateral externo de la grasa de Hoffa por edema como signo sugestivo de tendón rotuliano largo con rótula alta, y evaluar su sintomatología. Materiales y métodos: se evaluaron retrospectivamente una serie de pacientes y sus resonancias magnéticas de rodilla realizadas en nuestro centro entre 2019 y 2022. Se constató el edema en la región superoexterna de la grasa de Hoffa en los planos sagital, coronal y axial, se efectuaron las medidas de la altura rotuliana mediante el método de Insall-Salvati en la RM en un corte sagital en secuencia T2. Se evaluaron el motivo de consulta y la relación con la imagen observada. Resultados: se evaluaron un total de ciento diecinueve RM, que correspondían a ciento cuatro pacientes. En quince pacientes se analizaron ambas rodillas. Fueron sesenta y cinco de sexo femenino y treinta y nueve, masculino. La edad promedio fue 32.8 años (rango 14-75 años). Se evidenció edema superoexterno de grasa de Hoffa en todas las RM evaluadas, y se observó tendón patelar largo en ciento diecisiete rodillas, lo que representó el 98.3% de la muestra. La altura patelar promedio fue 1.49 según el índice IS (1.12-2.03). En dos RM (1.7%) se vio edema con altura patelar con valores normales de 1.12 y 1.18. Discusión: el edema superoexterno de la grasa de Hoffa tiene una fuerte relación con una altura patelar elevada. Se estudiaron en este trabajo estas variables y se trató de establecer una relación entre ellas. El método de evaluación de patela alta, el índice Insall-Salvati, es el más confiable. Varios estudios correlacionan el edema superoexterno y la patela alta, algunos de ellos asociadas a pacientes jóvenes, mientras que otros lo asocian a signos de artrosis y pacientes más añosos. En cuanto a los síntomas que ocasionan estos hallazgos, son poco claros. Conclusión: en el presente estudio se evidenció que existe una fuerte relación entre el edema superoexterno de la grasa de Hoffa y una patela alta, un signo muy útil a la hora de estudiar y entender la patología femororrotuliana. Observamos una mayor asociación con síntomas patelofemorales y traumatismos de rodilla. A pesar de que esto puede verse en otras patologías.

En cuanto a la patología de la porción larga del bíceps, la tenodesis proximal intraarticular nos ofrece la considerable ventaja de poder realizarla junto a diferentes procedimientos aprovechando los mismos abordajes de la artroscopía. Con la siguiente técnica buscamos una fijación simple, utilizando un implante económico y fácilmente accesible en nuestro medio, resolviendo algunos puntos críticos de falla señalados por la bibliografía. Para ello, combinamos un nudo en espiga para tomar el tejido hacia distal, junto a un punto de simple polea sobre el ojal del anclaje.

Eine 65-jährige Patientin stellte sich mit der Diagnose klaffende Tube vor. Sie litt seit Jahren an einer stark beeinträchtigenden Autophonie und hatte bereits diverse erfolglose Behandlungen hinter sich. Als Ultima Ratio wurde eine operative Maßnahme diskutiert. Die von mir durchgeführten osteopathischen Behandlungen führten primär nur zu kurz anhaltender Verbesserung der Symptome. Eine unbewusste permanente Anspannung der HWS-, Schulter- und Kiefergelenkmuskulatur – von der Patientin subjektiv nicht wahrgenommen – in Kombination mit einer Koordinationsstörung der orofazialen Muskulatur verhinderte einen anhaltenden Heilungserfolg. Für einen durchbrechenden Therapieerfolg waren neben der osteopathischen Behandlung eine intensive Wahrnehmungsschulung und tägliche Koordinationsübungen erforderlich. A 65-year-old female patient presented with a diagnosis of PET (patulous Eustachian tube). For years, she had been suffering from severely disabling autophonia and had already undergone various unsuccessful treatments. Surgery was discussed as the last resort. The osteopathic treatments I carried out primarily only led to a short-lasting improvement in the symptoms. An unconscious permanent tension of the cervical muscles, shoulder – and temporomandibular joint muscles – subjectively unperceived by the patient – in combination with a coordination disorder of the orofacial muscles prevented a lasting healing success. In addition to the osteopathic treatment an intensive perception training and daily coordination excercises were necessary for a successful treatment. [ABSTRACT FROM AUTHOR]

Hip fractures inflict heightened morbidity and mortality upon older adults. Although previous studies have explored the impact of individual demographic factors on hip fracture risk, a comprehensive review can help reconcile disparities among these factors. This meta-analysis encompassed 69 studies involving 976,677 participants and 99,298 cases of hip fractures. We found that age ≥ 85 (OR = 1.75), BMI < 18.5 (OR 1.72), female sex (OR = 1.23), history of falls (OR = 1.88), previous fractures (OR = 3.16), menopause (OR 7.21), history of maternal hip fractures (OR = 1.61), single and unmarried status (OR = 1.70), divorced status (OR 1.38), residing in a residential care facility (OR = 5.30), and living alone (OR = 1.47) were significantly associated with an increased incidence of hip fracture. Conversely, BMI ranging from 25 to 30 (OR = 0.59), BMI > 30 (OR = 0.38), parity (OR = 0.79), non-Caucasian descent (overall OR = 0.4, Asian OR 0.36, Black OR = 0.39, and Hispanic OR = 0.45), and rural residence (OR = 0.95) were significantly associated with a diminished risk of hip fracture. Hip fracture patients exhibited significantly lower weight and BMI than the non-fracture group, while their age was significantly higher. However, age at menopause and height did not significantly differ between the two groups.

We established a protocol for assessing the areal bone mineral density (BMD) of the proximal humerus using dual-energy X-ray absorptiometry (DXA). We also investigated the correlation between the BMD of the proximal humerus and that of the lumbar spine and proximal femur to predict the BMD of the proximal humerus. We included female patients aged >60 years who underwent bone density evaluation using DXA. The BMD of the proximal humerus was calculated at seven regions of interest (ROIs): the head of the humerus, lesser tubercle, greater tubercle in two locations, and proximal metaphysis in three locations. The intra- and inter-examiner reliabilities in the setting of the ROIs were examined using intraclass correlation coefficients (ICCs) (1.1) and (2.1), respectively, and the intra-examiner reliability in DXA was examined using ICCs (1.1). The intra- and inter-examiner reliabilities in the setting of ROIs and the intra-examiner reliability in DXA were high in all regions. The BMD of the lumbar spine and proximal femur correlated weakly with that of the humeral head and diaphysis. Our method for measuring the BMD of the proximal humerus was found to be reliable and may be applied in future studies.

Abstract Background Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.

A proportion of osteoarthritis (OA) patients are unsatisfied with post-operative outcomes following total joint replacement surgery (TJR), with insufficient pain relief or poor functional improvement. Predicting those who will have poor outcomes would be beneficial for patients and clinicians. The aim of this study was to determine the relationship between baseline anthropometric data and the concentration of pre-operative serum and peri-operative synovial fluid (SF) cytokines and 7-month post-operative outcomes in a cohort of knee and hip OA patients. 160 OA patients were recruited who were scheduled for TJR. The concentration of 24 cytokines was measured in blood and SF by multiplex assay. EQ5D index health status was assessed pre-operatively and at 7 months post-operatively. 13% of patients were identified as non-responders based on EQ5D index. Compared to responders, non-responders were of higher body mass index (BMI), had greater waist and hip circumference, and had higher levels of SF leptin but lower levels of SF resistin (p < 0.05). Linear regression analysis found a significant but weak relationship between pre-operative body weight and post-operative response (ΔEQ5D index; r = 0.222, p = 0.049). The combination of body weight with SF amphiregulin and SF IL-6 provided an improved predictive model of post-operative response (r = 0.470, p = 0.035).

Background: Monteggia fractures entail a proximal ulnar fracture with associated radial head dislocation. Primarily observed as a fracture in the pediatric population, there have been rare occurrences in adults. In rare instances, various associated fractures have been reported with Monteggia fractures. However, during our literature review, a type I Monteggia fracture had not been reported along with ipsilateral diaphyseal humerus and capitellar fractures. Here, we present a successful post-operative outcome for a unique fracture distribution and form of fixation that has yet to be reported in the literature.

Abstract Background Breastfeeding plays a primary role in the events that characterize the development of the relationship between a mother and her newborn. However, this essential process sometimes does not fully cover the nutritional requirements of the newborn due to altered biomechanical sucking skills. In this context, adequate osteopathic treatment associated with neuromotor facilitation techniques could play a promoting role. Methods This study evaluated the effect of the osteopathic approach using myofascial release on 26 infants with ineffective sucking ability, identified by the POFRAS scale and LATCH score, compared with 26 untreated similar infants. After the procedure was initially performed in the hospital, the strategy based on basic neuromotor patterns was taught to the parents to be continued at home. The effects were measured at hospital discharge, during the first outpatient visit, which occurred after about seven days, and at one month of life. Results The number of valid and continuous suctions, initially less than five per feed in both groups, at the first outpatient check-up was significantly higher (p

Gene therapy is gaining traction as an effective treatment for several deleterious disorders by delivering genetic material using viral or non-viral vectors to correct mutated genes. Research in the field focuses primarily on the treatment of cancers; however, it shows great promise for treating diseases related to pediatric orthopedics. This review aims to describe gene therapy’s application, efficacy and safety in pediatric orthopedics. This paper will examine common pediatric orthopedic disorders including Duchenne muscular dystrophy, osteogenesis imperfecta, spinal muscular atrophy and osteosarcoma. Overall, gene therapy for spinal muscular atrophy and Duchenne muscular dystrophy has made great advances with approved gene therapy drugs already in use, while therapy for osteogenesis imperfecta and osteosarcoma treatments is still widely preclinical but still promising. As a whole, gene therapy is rapidly advancing in the field of pediatric orthopedics; however, further research is crucial in continuing and spreading these advancements and for the treatment of other debilitating pediatric-related orthopedic disorders.

Background: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy, osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care. Purpose: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies. Methods: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements. Conclusions: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model. [ABSTRACT FROM AUTHOR]

Despite the care provided, some newborns, who are perfectly healthy, show functional alterations that impair a good breast attack in the first few days. This situation often leads to the early failure of lactation. We conducted a randomized single-blind controlled trial to evaluate whether four weeks of osteopathic treatment can normalize the sucking score in a group of neonates with impaired lactation ability. Forty-two healthy full-term neonates were enrolled in this study. On the basis of the sucking score and the assessment of the infant's breastfeeding skills, infants who had intrinsic breastfeeding difficulties were selected. The inclusion criteria were healthy infants born > 37 weeks, a suction score ≤ 6, and any breast milk at enrolment. At the end of the study, the sucking score was significantly greater in the osteopathic group than in the untreated group; the median sucking score in the treated group was in the normal range, while it remained lower in the untreated group. At the end of the follow-up, the percentage of exclusively breastfeeding infants in the treatment group increased by +25%. This pilot study demonstrates the efficacy of early osteopathic intervention to relieve breastfeeding difficulties in newborns in the first few weeks of life. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding plays a primary role in the events that characterize the development of the relationship between a mother and her newborn. However, this essential process sometimes does not fully cover the nutritional requirements of the newborn due to altered biomechanical sucking skills. In this context, adequate osteopathic treatment associated with neuromotor facilitation techniques could play a promoting role. Methods: This study evaluated the effect of the osteopathic approach using myofascial release on 26 infants with ineffective sucking ability, identified by the POFRAS scale and LATCH score, compared with 26 untreated similar infants. After the procedure was initially performed in the hospital, the strategy based on basic neuromotor patterns was taught to the parents to be continued at home. The effects were measured at hospital discharge, during the first outpatient visit, which occurred after about seven days, and at one month of life. Results: The number of valid and continuous suctions, initially less than five per feed in both groups, at the first outpatient check-up was significantly higher (p < 0.00001) in the treated group. Exclusive breastfeeding, initially present in all enrolled children, was maintained mainly in treated children, both at discharge (p < 0.003), at outpatient follow-up (p < 0.00001), and at one month of life (p < 0.00001). Differences in growth and health conditions were not found between the groups. Conclusion: We believe that osteopathic treatment associated with neuromotor facilitation techniques can optimize newborns' sucking skills, improving the acquisition and duration of breastfeeding. [ABSTRACT FROM AUTHOR]

Interdisciplinary interaction between osteopathic physicians and dentists is important due to the lack of consensus on the causes, development, and treatment of temporomandibular joint dysfunction (TMJD). To date, there is no unified classification that considers not only pathological processes in the joint itself and the adjacent musculotendinous apparatus, but also the influence of extraocclusal, i.e., extraarticular, pathologies on the development of TMJD. The aim of this study was to model occlusal and extraocclusal irregularities in a lab environment to illustrate their impact on mandibular biomechanics. The study involved twenty volunteers between the ages of 20 and 40, who underwent examinations by a dentist and an osteopathic doctor to rule out occlusal and extraocclusal disorders. Changes in the path lengths of the gnathion, gonion, mouth angle (mimic musculature), and pupils (postural sensor) during mouth opening and closing were compared. Recordings were taken at 5-minute intervals with intermediate osteopathic testing to exclude residual phenomena. The presence of occlusal and extraocclusal disorders significantly alters the biomechanics of the mandible (p<0.05). Modeling extraocclusal disorders resulted in a reduction in the path lengths of the measured points (p<0.05), which is consistent with the data obtained from testing for the presence of extraocclusal disorders. On the other hand, modeling occlusal disorders showed a significant increase in the path lengths of measured points (p<0.05). A significant increase in pupil movement path lengths was found, suggesting an adaptation of postural system due to sensor injury. The obtained results demonstrate the impact of occlusal and extraocclusal disorders on mandibular biomechanics. Further research is recommended with a larger number of participants and more examination parameters. [ABSTRACT FROM AUTHOR]

Studies of leg-length discrepancies (LLD) have been the subject of debate for almost 200 years. A large number of studies have emerged, most frequently using assessment criteria based on painful symptoms or joint damage. While many authors argue for a threshold of 10–20 mm to establish a link between pain and LLD, most publications based on radiography show lesion stigmata on lumbar, hip and knee joints as early as 6 mm. This would be linked to comorbidities. Some studies argue forcefully that leg-length correction below 20 mm is of no benefit. The authors of the present article, on the other hand, evoke the notion of lesion risks in the absence of correction, even for small deviations in the presence of certain associated factors and according to their importance. The authors argue for the need to define in the future a lesion significance score that would not be correlated to painful symptomatology, but rather to the presence of co-morbidities such as age, anatomical variability, sports practice and/or patients' professional activities. Other parameters, such as mobility, should also be taken into consideration, while gender, height and weight do not appear to be significantly related. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to examine the acute effect of osteopathic release of the thoracolumbar fascia on lower extremity functional performance, lumbar extensor endurance and mobility in professional soccer players. Materials and Methods: 30 volunteer male athletes who professionally play soccer participated in the study, and the participants were randomly divided into experimental and control groups. The functional performance of the lower extremities, lumbar extensor endurance and mobility of the subjects were measured twice - before and immediately after the Still Technique and placebo applications. Subjects' lower extremity functional performance was determined by the Single Leg Hop Test, lumbar extensor endurance by the Beiring-Sorensen Extensor Endurance Test, and mobility skill by the Modified Schober Test. Results: According to the results of the statistical analysis, there was a significant difference between the pre-test and posttest values of the lumbar extensor endurance tests of the experimental group in favor of the posttest; however, there was no significant difference in lower extremity functional performance and mobility values, and it was determined that they improved in the post-test. Conclusions: Releasing the thoracolumbar fascia tissue with osteopathic technique before exercise in athletes can acutely increase performance by positively affecting muscle contraction. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the clinical effectiveness of craniosacral therapy (CST) in the management of any conditions. Methods: Two independent reviewers searched the PubMed, Physiotherapy Evidence Database, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases in August 2023, and extracted data from randomized controlled trials (RCT) evaluating the clinical effectiveness of CST. The PEDro scale and Cochrane Risk of Bias 2 tool were used to assess the potential risk of bias in the included studies. The certainty of the evidence of each outcome variable was determined using GRADEpro. Quantitative synthesis was carried out with RevMan 5.4 software using random effect models. Data Synthesis: Fifteen RCTs were included in the qualitative and seven in the quantitative synthesis. For musculoskeletal disorders, the qualitative and quantitative synthesis suggested that CST produces no statistically significant or clinically relevant changes in pain and/or disability/impact in patients with headache disorders, neck pain, low back pain, pelvic girdle pain, or fibromyalgia. For non-musculoskeletal disorders, the qualitative and quantitative synthesis showed that CST was not effective for managing infant colic, preterm infants, cerebral palsy, or visual function deficits. Conclusions: The qualitative and quantitative synthesis of the evidence suggest that CST produces no benefits in any of the musculoskeletal or non-musculoskeletal conditions assessed. Two RCTs suggested statistically significant benefits of CST in children. However, both studies are seriously flawed, and their findings are thus likely to be false positive. [ABSTRACT FROM AUTHOR]

Hintergrund – Forschungsergebnisse zeigen, dass funktionelle Beschwerden durch körperliche, psychosoziale und verhaltensbezogene Aspekte beeinflusst werden können. Im Bereich der Osteopathie ist die Symptombelastung von Patient*innen aus einer mehrdimensionalen Perspektive nicht ausreichend untersucht. Methodik – Im Rahmen einer Fragebogenstudie mit 2 Durchläufen wurden in der Lehrpraxis der OSD Berlin Patient*innen befragt. Auf Basis des 1. Durchlaufes (n = 121) wurde die Häufigkeit erfüllter Cut-off-Kriterien für Angst und Depression (HADS-D) berechnet und die Verteilung auf die Schweregrade chronischer Schmerzen (CPG) bestimmt. Für den 2. Durchlauf (n = 167) wurden Mittelwerte der biopsychosozialen Belastung (KPD-38) berechnet. Anhand von Cut-off-Kriterien für SSS-8 und SSD-12 wurde ein Screening für die somatische Belastungsstörung des DSM-5 durchgeführt. Des Weiteren wurden Korrelationsprüfungen zwischen ausgewählten psychosozialen, verhaltensbezogenen und körperlichen Skalen sowie der Symptomdauer und dem Lebensalter durchgeführt. Ergebnisse – Die aktuellen Körperbeschwerden bestanden im Durchschnitt 5,6 Jahre (Median: 3 Jahre). Durch Müdigkeit oder Energiemangel fühlten sich die Studienteilnehmer*innen am häufigsten stark bis sehr stark beeinträchtigt (29,4 %), gefolgt von Schmerzen des Rückens (28,2 %) und der Extremitäten (17,4 %). 12,6 % der Studienteilnehmer*innen erfüllen die Kriterien der somatischen Belastungsstörung des DSM-5. Es wurden signifikante Zusammenhänge zwischen Faktoren der psychosozialen bzw. verhaltensbezogenen und der körperlichen Beeinträchtigungsdimension gezeigt. 22,3 % der Personen im 1. Durchlauf zeigten eine klare Angstproblematik und die Angst-Cut-off-Kriterien wurden mit steigendem Grad der Schmerzchronifizierung häufiger erfüllt. Schlussfolgerung – Die Ergebnisse deuten darauf hin, dass die Patient*innen der osteopathischen Lehrpraxis insbesondere unter chronischen Beschwerden leiden, die sich sowohl auf körperlicher als auch auf psychosozialer und verhaltensbezogener Ebene zeigen, und dass über diese Ebenen hinweg deutliche Zusammenhänge bestehen. Background – Research results show that functional somatic disorders are subject to biological, psychological and behavioural influences. In the field of osteopathy, the symptom burden of patients has not been sufficiently studied from a multidimensional perspective. Methods – As part of a questionnaire study with two runs, patients in the osteopathic teaching practice of OSD Berlin were surveyed. Based on the first run (n = 121), the frequency of fulfilled cut-off criteria for anxiety and depression (HADS-D) was calculated and the distribution to the severity levels of chronic pain (CPG) was determined. For the second run (n = 167), average values for biopsychosocial stress (KPD-38) were calculated. Screening for somatic stress disorder according DSM-V was performed by using cut-off criteria for SSS-8 and SSD-12. Moreover, a correlation test was carried out between selected psychosocial, behavioural and physical scales as well as the duration of symptoms and the age. Results – The current physical complaints persisted for an average of about 5.6 years (median – 3 years). The study participants most often feel severely to very severely impaired by fatigue or lack of energy (29.4 %), followed by back pain (28.2 %) and pain in the extremities (17.4 %). 12.6 % of the study participants met the criteria for somatic stress disorder. Significant correlations were shown between factors of the psychosocial or behavioural dimension and the physical impairment dimension. Furthermore, 22,3 % of the first run showed a clear anxiety issue and the anxiety cut-off-criteria were met more frequently with an increasing degree of pain chronification. Conclusion – The results indicate that the patients in the osteopathic teaching practice mainly suffer from chronic complaints that manifest themselves on a physical as well as on a psychosocial and behavioural level, and that there are clear connections across these levels. [ABSTRACT FROM AUTHOR]

Grundlage dieses Artikels ist eine Masterarbeit, die osteopathische Behandlungsmöglichkeiten bei den chronisch entzündlichen Darmerkrankungen (CED) Morbus Crohn (MC) und Colitis ulcerosa (CU) untersucht. Die langjährig stattgefundene schulmedizinische Forschung bündelt in den stetig aktualisierten S3-Leitlinien für beide Krankheitsbilder. Auch innerhalb der Osteopathie existiert bereits Forschung zu Behandlungsmöglichkeiten von CED. Sie beschränkt sich jedoch auf nur einzelne Studien und kann somit nicht als allgemein gültig angesehen werden. Diese qualitative Forschungsarbeit versucht, anhand von Interviews MC und CU in der osteopathischen Praxis mit all seinen Facetten zu erfassen. This article is based on a master's thesis which examined osteopathic treatment options for the inflammatory bowel diseases (IBD) Crohn's disease (MC) and ulcerative colitis (UC). The many years of research in conventional medicine is reflected in the existence of comprehensive S3 guidelines for both diseases. Although there is also already research within osteopathy on treatment options for IBD, it is actually limited to individual studies and therefore cannot be regarded as generally valid. This qualitative research attempted to capture MC and UC in osteopathic practice with all its facets. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: Functional constipation (FC) is a common global high prevalence issue in children. Objective: The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment. Methods: This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report. Results: At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (P0.05). In the intervention group comparison, statistically significant differences were found in all variables except the Bristol stool form scale (P

Craniofacial surgery is proposed and performed for a variety of reasons, ranging from congenital or acquired malformations to emotional disorders and parafunctions of the masticatory, respiratory, auditory, and visual systems. Surgery of the mandible and its orthostatic repositioning is the most common of these corrections of craniofacial anomalies. Throughout the history of these procedures, various techniques have been proposed and perfected, but always with a high rate of minor and major complications. The recurrence rate of mandibular malposition is high, as is the temporary loss of facial sensitivity and motor skills. These outcomes are often related to the choice of surgical technique rather than the skill of the surgeon, which is considered to be one of the most important factors in the final outcome. Surgical techniques involving direct manipulation of the vascular-nervous bundles, such as bilateral sagittal split osteotomy, clearly present the possibility of major or minor complications. In this study, an orthognathic surgical technique, performed by the same team for over 40 years and now available through a 20-year postoperative patient follow-up study, is presented with a literature review relating it to biomechanical concepts and bone remodeling to analyze the evolution of orthognathic surgery since it became common practice to correct maxillofacial discrepancies. In this review, we also present a case report in which previous orthodontic treatment prepared a patient for surgical correction of mandibular bone discrepancy without the need for combined maxillary and/or genioplasty, and we describe the most commonly used techniques today, as well as their advantages and disadvantages. The combination of established concepts together promotes favorable stability of mandibular osteotomies, functional anatomical positioning of the temporomandibular joint, reduced risk of injury to the mandibular vasculo-nervous bundle, and good aesthetics with positive patient acceptance and no relapse, thus these are the objectives for proposing innovative treatments that combine the technologies available today.

Bone fractures following mandibular dental implant protocols associated with diagnosed osteoporosis are rare in the literature. We present a case in which a 55-year-old male patient with no previous medical history presented to the emergency department with pain in the left mandibular parasymphysis and gingival bleeding. Clinical examination revealed crepitus, mandibular mobility, and clinical signs of localized fracture and infection. Further radiographs confirmed a mandibular fracture in the region of the alveolus of tooth 34 and four implants placed in the mandible as part of the patient’s immediate implant protocol. The infection developed into osteomyelitis, which was treated with a combination of antibiotics. After the infectious process had been eradicated, new complementary tests were carried out, which revealed that the patient had osteoporosis. Oral rehabilitation treatment and calcium replacement were carried out under specialist medical supervision. The importance of proper planning and clinical assessment of the patient is discussed, and the proposed long-term management of the case has been carried out.

Today, dental implantology represents a reliable technique for treating both partial and total edentulism. The fixation of dentures on dental implants can be achieved using various techniques, where the choice of a specific technique depends on the patient’s individual needs, the jawbone’s condition, and the prosthesis design. Currently, the two most common types of prosthetic abutment connections are cemented and screwed, each with its own set of advantages and disadvantages. This study aimed to analyze a novel Morse cone connection system between the prosthesis and implant using finite element analysis (FEA). The analysis of connection retention was conducted using three different approaches: analytical, in vitro, and FEA. Three-dimensional models were created for systems comprising an abutment, healing cap, and crown under three inclination conditions: 0°, 15°, and 30°. Using Ansys finite element software (R1 2023), the impact of the tilt on the system retention was examined. The FEA showed results comparable with the in vitro studies regarding the retention strength for an abutment cap system with a 4° taper, obtaining 66.6 N compared with the 68 N calculated in our in vitro study. The inclination of the abutment affected the system retention due to the hole made in the abutment’s surface, decreasing the contact area between components. The Morse cone prosthesis–implant connection system was found to be the most stable and efficient compared with threaded or cemented systems. The retention was influenced by factors such as the abutment conicity, insertion strength, and the contact surface between components.

The International Consortium on Manual Therapies (ICMT) is a grassroots interprofessional association open to any formally trained practitioner of manual therapy (MT) and basic scientists promoting research related to the practice of MT. Currently, MT research is impeded by professions' lack of communication with other MT professions, biases, and vernacular. Current ICMT goals are to minimize these barriers, compare MT techniques, and establish an interprofessional MT glossary. Practitioners from all professions with training in manual therapies were encouraged by e-mail and website to participate (). Video conferences were conducted at least bimonthly for 2.5 years by profession-specific and interprofessional focus groups (FGs). Members summarized scopes of practice, technique descriptions, associated mechanisms of action (MOA), and glossary terms. Each profession presented their work to the interprofessional FG to promote dialogue, understanding and consensus. Outcomes were reported and refined at numerous public events. Focus groups with representatives from 5 MT professions, chiropractic, massage therapy, osteopathic, physical therapy and structural integration identified 17 targeting osseous structures and 49 targeting nonosseous structures. Thirty-two techniques appeared distinct to a specific profession, and 13 were used by more than 1. Comparing descriptions identified additional commonalities. All professions agreed on 4 MOA categories for MT. A glossary of 280 terms and definitions was consolidated, representing key concepts in MT. Twenty-one terms were used by all MT professions and basic scientists. Five terms were used by MT professions exclusive of basic scientists. Outcomes suggested a third to a half of techniques used in MT are similar across professions. Additional research is needed to better define the extent of similarity and how to consistently identify those approaches. Ongoing expansion and refinement of the glossary is necessary to promote descriptive clarity and facilitate communication between practitioners and basic scientists. [ABSTRACT FROM AUTHOR]

Lumbar vertebral bone attenuation, measured in Hounsfield units (HU) can indirectly indicate the bone mineral density (BMD). The aim of this study is to determine the optimal HU threshold on abdominal computed tomography (CT) scans to detect osteopathy in patients with chronic pancreatitis (CP). This cross-sectional study included patients with CP who underwent CT scans to measure HU at L1 to L4 vertebrae. The mean lumbar vertebral attenuation of female renal transplant donors, aged 20–30 years was utilized to calculate the T-scoreHU of all patients at each vertebral level. Receiver operator characteristic analysis was used to determine the HU and T-scoreHU for diagnosis of osteopathy in patients with CP. Dual-energy X-ray absorptiometry value was used to categorize osteopenia and osteoporosis. A total of 175 patients (mean age, 34.5 ± 10.9 years; 72 % males) and 33 female renal transplant donors (mean age, 28 ± 2.4 years) were included. A threshold HU value 212 or T scoreHU of −1.80 at L1 vertebra was found to have a 78 % sensitivity and 70 % specificity for differentiating between osteoporosis and non-osteoporosis (osteopenia and normal BMD). Similarly, a threshold HU value of 254 or a T-scoreHU of −0.46 at L1 vertebra had 78 % sensitivity and 71 % specificity for distinguishing between normal and low BMD (osteoporosis and osteopenia). Abdominal CT images, which are routinely performed in chronic pancreatitis, can be used for opportunistic screening of osteoporosis and osteopenia without additional cost or radiation exposure. [ABSTRACT FROM AUTHOR]

Introduction: Osteopathy was originally introduced in rural America in 1874 as a comprehensive therapeutic approach aimed at promoting health. This approach was distinct and often conflicting with conventional/allopathic therapeutic methods available at that time to fight disease. We argue that, in struggling to achieve recognition within the American healthcare system and within the educational academic field that was about to be structured, the American osteopathic profession tried to protect itself from the charges of sectarism by starting to embrace principles of the biomedical paradigm. Methods: A comparative and historiographic review of the second version of the autobiography of AT Still (1908), the founder of osteopathy, against the first (1897) was chosen as an example of the adaptation of the American osteopathic profession to its evolving academic environment. Results: Although there were only a few substantial variations, we argue that they aimed to dampen the non-biological components of osteopathy, namely, its philosophical, spiritual, religious, emotional, and Native American roots, in an effort to gain respect and recognition within the emerging gold standard of the Western medical system. The shift towards a distinct, fully integrated profession within regulated Western healthcare systems was perceived by many professionals as a threat to AT Still's original ideas, and the trend started when he was alive. Conclusion: Our findings suggest that a crucial conversation regarding the future of the professional identity must take place within the osteopathic community. [ABSTRACT FROM AUTHOR]

Low back pain is a real public health problem. Today's pain management programs use drug treatments in addition to non-drug therapies. Osteopathic manipulative treatment (OMT) is presented here: a study of 48 patients suffering from type L5 low back pain and treated osteopathically. The treatment consisted of a Osteo-pathic protocol in 2 sessions (OP2S), developed at the Nouméa pain center (New Caledonia), in which L5 manipulation is performed only in the second session. Of the 48 patients included, 46 were treated, 41 were cured or improved at one year after treatment with two sessions (89%), and 28 were cured or improved from the first session (61%). In cases of type L5 low back pain, local osteopathic treatments were sometimes aimed at osteopathic manipulation of the L5 vertebra. We believe that this local manipulative treatment is delicate in the first line, as L5 inflammation is often secondary to nearby or distant osteopathic dysfunctions. Conclusion This first study from the PO2S research project suggests that osteopathic proto-colization is possible, osteopathy has a place in the type L5 low back pain treatment, and L5 manipulation is unnecessary in 61% of cases. Randomized studies will have to confirm these hypotheses. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVDs) are the leading cause of death globally. Morbidity and disability related to non-fatal events are increasing exponentially. There are several symptoms that may arise after invasive therapeutic approaches such as coronary artery bypass graft (CABG), including chronic pain in anatomical areas connected to the mediastinum; these pains can be found not only initially after surgery but also years later. We present a case where non-specific neck pain (NNP), in a patient undergoing CABG five years earlier, was resolved with an osteopathic technique, working the pericardial area. To the knowledge of the authors, it is the first article illustrating an osteopathic approach with resolution of NNP, with a manual technique used on the pericardial area. [ABSTRACT FROM AUTHOR]