Phrathep Davong D, Abdo Zach, Tadros Mariam, Lewandowski Emily, Evans John
Mayo Clinic, Jacksonville, FL, USA.
Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA.
J Osteopath Med. 2024 Nov 25;125(4):203-211. doi: 10.1515/jom-2024-0094. eCollection 2025 Apr 1.
Dystonia is a movement disorder that causes involuntary muscle contractions leading to abnormal movements and postures, such as twisting. Dystonia is the third most common movement disorder in the United States, with as many as 250,000 people affected. Because of its complexity, dystonia presents a significant challenge in terms of management and treatment. Despite limited research, osteopathic manipulative treatment (OMT) has been considered as an adjunctive treatment due to its inexpensive and noninvasive nature, as opposed to other modalities such as botulinum toxin injections, deep brain stimulation (DBS), and transcranial magnetic stimulation, which are often expensive and inaccessible. OMT treatments performed in case studies and series such as balanced ligamentous tension/articular ligamentous strain (BLT/ALS), muscle energy (ME), high-velocity low-amplitude (HVLA), and myofascial release (MFR) have shown reduction of pain and muscle hypertonicity, including in patients with dystonia.
The studies reviewed in this paper provide a snapshot of the literature regarding the current evidence of OMT's role for dystonia.
A medical reference librarian conducted a thorough literature search across multiple databases including PubMed and Google Scholar to find articles relevant to the use of OMT for dystonia. The search employed a combination of Medical Subject Headings (MeSH) terms and keywords related to osteopathic medicine and dystonia to ensure precise retrieval of relevant articles within the last 20 years. Despite limited research on the topic, all four relevant reports found in the literature were selected for review.
Of the four relevant reports, case series and studies highlighted the potential benefits of OMT in managing dystonia, particularly cervical dystonia and foot dystonia. OMT has shown promising results addressing pain, stiffness, and impaired motor function. In cases of foot dystonia in Parkinson's disease, OMT has helped improve gait and reduce pain by targeting somatic dysfunctions (SDs) associated with dystonia, such as abnormalities in foot progression angle (FPA) and musculoskeletal imbalances. Also, OMT has been found to alleviate symptoms of cervical dystonia, including tremors, muscle spasms, and neck stiffness. These interventions performed in case studies and series led to improvements in gait biomechanics in foot dystonia and overall symptom severity in patients with cervical dystonia.
Currently, botulinum toxin, oral medications, physical therapy, and rehabilitation are commonly utilized in managing dystonia. The studies reviewed in this paper suggest that these treatments may lead to improvements in pain and muscle hypertonicity in patients with dystonia. It is important to investigate whether factors such as the type of dystonia (eg, focal vs. segmental) and its underlying cause (eg, idiopathic, trauma, infection, autoimmune, medication side effects) influence treatment outcomes. Further research is recommended to explore the role of OMT in managing dystonia.
肌张力障碍是一种运动障碍，会导致非自愿性肌肉收缩，从而引起异常运动和姿势，如扭转。肌张力障碍是美国第三常见的运动障碍，受影响人数多达25万。由于其复杂性，肌张力障碍在管理和治疗方面带来了重大挑战。尽管研究有限，但整骨手法治疗（OMT）因其成本低廉且无创的特性，被视为一种辅助治疗方法，这与肉毒杆菌毒素注射、深部脑刺激（DBS）和经颅磁刺激等其他治疗方式不同，后者往往成本高昂且难以获得。在案例研究和系列研究中进行的OMT治疗，如平衡韧带张力/关节韧带应变（BLT/ALS）、肌肉能量（ME）、高速低振幅（HVLA）和肌筋膜松解（MFR），已显示出可减轻疼痛和肌肉高张力，包括肌张力障碍患者。
本文综述的研究提供了关于OMT在肌张力障碍中作用的当前证据的文献快照。
医学参考馆员在包括PubMed和谷歌学术在内的多个数据库中进行了全面的文献检索，以查找与使用OMT治疗肌张力障碍相关的文章。检索采用医学主题词（MeSH）术语与整骨医学和肌张力障碍相关关键词的组合，以确保在过去20年内精确检索相关文章。尽管关于该主题的研究有限，但文献中找到的所有四篇相关报告均被选入进行综述。
在这四篇相关报告中，案例系列和研究突出了OMT在管理肌张力障碍方面的潜在益处，特别是颈部肌张力障碍和足部肌张力障碍。OMT在解决疼痛、僵硬和运动功能受损方面已显示出有前景的结果。在帕金森病足部肌张力障碍的案例中，OMT通过针对与肌张力障碍相关的躯体功能障碍（SDs），如足部前进角度（FPA）异常和肌肉骨骼失衡，帮助改善了步态并减轻了疼痛。此外，已发现OMT可缓解颈部肌张力障碍的症状，包括震颤、肌肉痉挛和颈部僵硬。这些在案例研究和系列研究中进行的干预措施改善了足部肌张力障碍的步态生物力学以及颈部肌张力障碍患者的总体症状严重程度。
目前，肉毒杆菌毒素、口服药物、物理治疗和康复通常用于管理肌张力障碍。本文综述的研究表明，这些治疗可能会改善肌张力障碍患者的疼痛和肌肉高张力。重要 的是要研究诸如肌张力障碍类型（例如，局灶性与节段性）及其潜在原因（例如，特发性、创伤、感染、自身免疫、药物副作用）等因素是否会影响治疗结果。建议进一步研究以探索OMT在管理肌张力障碍中的作用。
