Il Trattamento Manipolativo Osteopatico modifica la perfusione cerebrale in soggetti con disfunzione osteopatica

Il concetto alla base del Trattamento Manipolativo Osteopatico (TMO) è quello di aiutare il corpo nel processo di guarigione, così come nel vivere in una situazione di equilibrio, economia e comfort, sia rispetto all’ambiente interno che esterno. Il TMO è stato negli ultimi anni oggetto di diversi studi scientifici che ne dimostrano l’efficacia clinica. Ciò nonostante non sono presenti ricerche finalizzate ad individuare i suoi effetti specifici sulla perfusione cerebrale, ovvero sulla vascolarizzazione delle differenti aree cerebrali.

A tale scopo Federica Tamburella, Federica Piras, Fabrizio Piras, Barbara Spanò, Marco Tramontano, Tommaso Gili hanno formato un team multidisciplinare di osteopati, psicologi, fisici e medici (tutti facenti parte della IRCCS Fondazione Santa Lucia di Roma) con lo scopo di studiare, attraverso l’utilizzo della risonanza magnetica, la variazione della perfusione cerebrale in soggetti giovani asintomatici.

Nello specifico è stata adottata la metodica detta “Arterial Spine Labeling” (ASL) per indagare sui livelli di perfusione cerebrale pre e post trattamento a livello di ogni area cerebrale. I dati dei soggetti trattati con TMO sono stati confrontati con un gruppo omogeno di pazienti sottoposti a trattamento placebo (SHAM), in cui gli osteopati hanno simulato un TMO, cosa di cui i pazienti non erano a conoscenza. Inoltre, oltre a valutare gli effetti a distanza di pochi minuti dal trattamento, è stata eseguita un’ulteriore risonanza magnetica a distanza di 72 ore.

Lo studio randomizzato, approvato dal Comitato Etico della Fondazione Santa Lucia, prevedeva l’assegnazione dei pazienti a uno dei gruppi TMO o SHAM in modalità del tutto casuale, con terapie osteopatiche individualizzate comprendenti le disfunzioni somatiche presenti ad ogni livello del corpo.

Diverse le tecniche di trattamento, scelte in base a una precisa diagnosi osteopatica e applicate sulle disfunzioni somatiche più severe e rilevanti di tutto il corpo, nel pieno rispetto dell’approccio olistico, concetto cardine dell’osteopatia.

Notevoli i risultati della ricerca (condotta su un campione di 30 soggetti, 15 per gruppo, con due osteopati per terapia). Confrontando i dati dei due gruppi, OMT e SHAM, è emerso che il trattamento osteopatico individualizzato globale induce dei cambiamenti nella perfusione cerebrale in soggetti sani asintomatici fin da subito, con modifiche riscontrate a livello di due aree cerebrali, la corteccia cingolata posteriore (PCC) e il lobo parietale superiore (SPL).

A carico della PCC gli autori hanno osservato un’iniziale riduzione della perfusione immediatamente dopo il TMO, seguita da un suo re-incremento a distanza di tre giorni come effetto a breve termine. LA PCC è considerata un nodo critico della cosiddetta “Central Autonomic Network” (CAN), vera e propria rete che controlla l’attività dei motoneuroni del sistema nervoso vegetativo.

L’ipotesi è che la diminuzione iniziale della perfusione della PCC possa indicare l’effetto vasocostrittore conseguente alla risposta simpatica del sistema nervoso autonomo; mentre l’aumento della perfusione tre giorni dopo l’intervento potrebbe rappresentare il successivo passaggio a un ambiente parasimpatico, con conseguente vasodilatazione e aumento della perfusione.

Da sottolineare che studi recenti suggeriscono che la PCC ha anche un ruolo centrale nel supportare la cognizione internamente diretta, essendo responsabile dell’integrazione della localizzazione spaziale corporale, dunque risulta molto importante ai fini dell’esperienza coerente del sé corporeo nello spazio (Guterstam A et al, 2015). Viene così identificata come un pre-processore emotivo che valuta l’auto-rilevanza di eventi emozionali e stimoli esterni. Ciò indica che il TMO è in grado di influenzare anche la capacità del corpo di pre-processare le sollecitazioni provenienti da fuori.

Oltre alla PCC, la perfusione risulta ridotta immediatamente dopo il TMO anche nel SPL, un’area principalmente coinvolta nelle funzioni visuomotorie e nella cognizione spaziale, specificamente legata alla generazione e al mantenimento dell’immagine corporea. Il risultato dell’integrazione di input visivi e propriocettivi è infatti l’aggiornamento della stessa immagine del corpo rappresentata in SPL.

In base ai risultati ottenuti, gli autori ipotizzano che le afferenze somato-sensoriali derivanti dal TMO possano condurre a effetti transitori sull’integrazione degli input e sul senso di proprietà del corpo.

In conclusione, la riorganizzazione dovuta al TMO genera effetti immediati che creano anche alterazioni a distanza di 72 ore sull’immagine del proprio corpo e sul senso di appartenenza allo stesso, così come conseguenze sul sistema nervoso vegetativo. Gli esiti specifici del TMO sul SPL sono invece transitori, suggerendo che la sua influenza sulla configurazione spaziale corporea sia passeggera; mentre gli effetti a breve termine sulla perfusione della PCC hanno un’influenza più duratura sulla rete autonomica centrale CAN.

Lo studio è stato condotto su soggetti asintomatici, il che significa senza dolore ma non senza disfunzioni. Questo rappresenta un punto importante della ricerca in quanto le disfunzioni somatiche producono effetti ancor prima di indurre dolore e il loro trattamento genera modificazioni neurovegetative oggettivabili a livello cerebrale.

Altro punto di forza della ricerca è il gruppo di controllo con placebo manuale, argomento molto discusso in letteratura visto che un tocco può generare reazioni anche senza volerlo. L’efficacia del placebo è stata monitorata con un questionario in cieco somministrato da una psicologa esterna, in modo tale da verificare come anche nei soggetti del gruppo placebo ci fosse la percezione di essere stati sottoposti a un trattamento sperimentale.

Tirando le somme, le modificazioni cerebrali registrate sono frutto dell’effetto specifico bottom-up del trattamento osteopatico, in cui la grande differenza è rappresentata proprio dalla nostra intenzione: “la più alta espressione su un profilo energetico di un processo logico”, ovvero il trasferimento del nostro background teorico-pratico attraverso il tocco.
dott. Luongo Luca
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    contain a high percentage of glue. They vary greatly in consistency, being either heavier or lighter than ointment-based pastes, and as such are stiffer and thicker.
    In addition to being stiffer, hibp pastes tend to be
    more dense, which gives them a better ability to hide defects and stay put
    longer.

    Personal information may be transmitted via hibp pastes.

    Because of the heavy nature of the paste, many businesses choose to
    only provide information on their company website
    or to partners through these pastes. This allows those who need the personal
    information to access it without compromising the company’s website, allowing
    them to still sell products or communicate with past
    and current customers. The information that can be transmitted through hibp pastes includes
    full names, email addresses, contact information, address history, and recent
    additions to the company’s database. As a result, many of the
    most popular and reliable pasting services do not advertise their ability to transmit personal information; this makes it much more difficult
    for a hacker to obtain a client’s personal information through a
    paste site.

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