Objective: To determine if osteopathic manipulative medicine (OMM) can improve gait biomechanics in people with cervical dystonia (CD).

Background: CD is a neurological disorder characterized by involuntary muscle contraction in the neck. Previous research has used the clinical neurological exam to determine that CD adversely affects gait. Hoffland et al. found a significantly slower walking speed and reduced confidence in ones own balance in CD subjects, however, the factors contributing to the effects of CD on gait remain unclear. OMM utilizes manual forces directed to improve function and homeostasis. It has previously been used to improve improve gait in Parkinson’s disease. Foot progression is the angle or the position of the foot with respect to the line of walking progression.

Methods: IRB-approval 983. Independently ambulating men, women, and children with CD symptoms beginning before the age of 40 not due to accident or injury were included. Foot progression biomechanics for one gait cycle in CD subjects were captured with Vicon cameras before and after 5 weekly 30 min OMM treatments. Joint angles were quantified using Vicon Nexus and Polygon 4.1 and, then, compared to published healthy values to determine abnormalities. TWSTRs and CD impact profile (CDIP-58) validated scales were used to determine the changes in symptom severity with 5 weekly OMM treatments. Osteopathic physical exams and OMM were performed by the investigating board certified physicians. The OMM procedure was applied to improve muscle balance and joint alignment of the feet, knees, pelvis, sacrum, spine, respiratory diaphragm, ribs, abdominal musculature, head, neck, and shoulders.

Results: Before OMM, the average degrees of foot progression angles beyond normal values at 0, 20, 40, 60, 80, and 100% of one gait cycle per subject was 5.13 (n=5). The same measures showed significant improvement after 5 weekly interventions, 0.21 (p=0.041). There was a mean improvement of 10% (+/-4) in CDIP-58.

Conclusions: CD subjects demonstrated abnormal foot progression signifying abnormal loading on the hip flexors and pelvic muscles. Five weekly OMM treatments significantly improved foot progression in CD suggesting OMM may be used to increase support during both the double support phase and single limb support when the opposite limb is in advanced swing.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improvement-of-foot-progression-in-cervical-dystonia-using-osteopathic-manipulative-medicine/