Application of osteopathic correction in complex therapy of patients with varicose veins of the lower limbs

Introduction. Modern methods of therapy of chronic venous insufficiency in general and varicose veins in particular often do not take into account the trigger factor of venous outflow disturbance development and are mainly aimed at reducing symptomatic manifestations of the disease. As a consequence — low efficiency of conservative therapy and increase in the number of operative treatments, decrease in the quality of life in patients with varicose veins, which should not escape the attention of clinicians. At the same time, it can be assumed that osteopathic approach in work with patients suffering from varicose veins, can not only influence the cause that led to the violation of venous blood outflow from the lower extremities, but also improve the quality of life of this group of patients. One of the modern works on the correction of venous insufficiency using osteopathic correction was carried out on patients with degree C2-3 according to the international classification of СЕАР, but this study did not include patients with already existing reflux in the superficial veins. The aim of the study : to evaluate the clinical efficacy of osteopathic correction in the complex therapy of patients with varicose veins of the lower limbs with the presence of pathological reflux on the superficial veins. Materials and methods. The prospective controlled randomized study was conducted in the period from March 2022 to December 2022 based on the Sverdlovsk Regional Hospital № 2 (Ekaterinburg). There were 44 female patients aged 30 to 60 years with the diagnosis of «varicose veins of the lower limbs», with the presence of pathological reflux in the superficial veins of the lower limbs according to ultrasound diagnostics. According to the exclusion criteria, 4 people dropped out. Depending on the applied treatment scheme, all observed patients were divided into equal 2 groups of 20 people each — main and control — using randomization envelopes. Patients of both main and control groups received complex conservative treatment in accordance with the approved clinical recommendations: compression therapy, drug therapy. Patients of the main group additionally received 2 sessions of osteopathic correction with an interval of 14 days. All patients were assessed for osteopathic status, quality of life, pain syndrome severity and ultrasonic diagnostics with measurement of the diameter of superficial veins of the lower limbs. Assessment and measurements were performed before treatment and 1 month after the start of treatment. Results. Dysfunctions of the following regions were most characteristic for patients with varicose veins of the lower limbs: lumbar, structural [in 6 (30 %) patients of both main and control groups] and visceral components [in 12 (60 %) and 10 (50 %) patients, respectively]; pelvis, structural [in 7 (35 %) and 6 (30 %) patients, respectively] and visceral components [in 13 (65 %) and 12 (60 %) patients of the main and control groups, respectively]. After treatment, only in the patients of the main group a statistically significant ( p <0,05) decrease in the frequency of detection of regional biomechanical disorders of the pelvic and lumbar region (structural and visceral component) was obtained. For the other SDs the differences were not significant. The examined patients were characterized by pain syndrome of moderate severity and a decrease in the level of quality of life. Only the conducted complex treatment with the use of osteopathic correction led to a significant ( p <0,05) decrease in the intensity of pain syndrome and improvement of the quality-of-life indicators, while in the patients of the control group these indicators practically did not change. Ultrasound diagnostics showed no significant changes in the diameter of superficial veins of the lower limbs in the observed patients in any of the groups. Conclusion. The use of osteopathic correction within the complex therapy of patients with varicose veins of the lower extremities allows to achieve a statistically more significant decrease in the intensity of pain syndrome and improve the quality of life compared to conventional compression and drug therapy. It is reasonable to continue the study on a larger sample of patients.