L’institut Dauphine d’Ostéopathie Federal European ...€¦ · L’institut Dauphine...

L’institut Dauphine d’Ostéopathie

en partenariat avec le

Federal European Register of Osteopaths

Promotion 2013

MEMOIRE n°71 Présenté et soutenu publiquement le X octobre à Paris par

M. ROUFFIGNAC Grégoire, né(e) le 01/04/1988 à Tassin la demi-lune (69).

Pour l’obtention du

DIPLÔME d’OSTÉOPATHE (D.O.)

LE TRAITEMENT DE L’OAA, INDISPENSABLE ?

Membres du jury :

Président :

Assesseurs :

Directeur du mémoire : Arnaud LEFÈVRE

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I. INTRODUCTION...........................................................................................................5

II. MATERIELS ET METHODES ..................................................................................9

A. OSTEOPATHIE ET POSTUROLOGIE ...............................................................................9 1. Scheibel A., Debusschere M. ..................................................................................9 2. Poret B. ..................................................................................................................10 3. Benoît-Lévy R., Scheibel A. ..................................................................................10

B. OSTEOPATHIE ET REGION SOUS-OCCIPITALE ...........................................................11 1. Anatomie ...............................................................................................................11 2. Base du crâne et dysfonctionnement parasympathique (IX, X) ........................14 3. Lien entre problèmes oculaires et rachis suboccipital ......................................16 4. Lien entre problèmes dentaires et rachis suboccipital ......................................21 5. Lien entre les céphalées et rachis suboccipital ...................................................22 6. Lien entre les muscles Vernier et la dure-mère ................................................25 7. L’intégration et le système synergique autoentretenu .......................................26

C. PRESENTATION DE LA POPULATION ..........................................................................28 1. Population ..............................................................................................................28 2. Critères d’exclusions .............................................................................................29 3. Informations relatives aux groupes ......................................................................30

D. PRESENTATION DES QUESTIONNAIRES .....................................................................31 1. Format des questionnaires ....................................................................................31 2. Intérêts des questionnaires....................................................................................31

E. DEROULEMENT DE L’ETUDE ......................................................................................32 1. Protocole expérimental..........................................................................................32 2. Démarche intellectuelle.........................................................................................33

F. PROTOCOLE DE TESTS ................................................................................................34 1. Bilan morphostatique ..........................................................................................35 2. Examen de la corticalité........................................................................................36 3. Test de Romberg postural......................................................................................37 4. Test des hauteurs de mains : TFD devant ...........................................................38 5. Test de piétinement de Fukuda .............................................................................39 6. Choix des tests........................................................................................................41

G. PROTOCOLE DE TRAITEMENT ....................................................................................43 1. Traitement ostéopathique ......................................................................................43 2. Traitement Placebo................................................................................................44

H. METHODES DE CLASSIFICATION ...............................................................................44 1. Classification 1 : Groupe témoin..........................................................................45 2. Classification 2 : Groupe Placebo........................................................................46 3. Classification 3 : Groupe test ...............................................................................47

I. LIMITES DE L’ETUDE ...................................................................................................48

III. RESULTATS ..............................................................................................................49

A. RESULTATS SUR L’ENSEMBLE DE LA POPULATION ..................................................49 1. Classification 1 : Groupe témoin..........................................................................50 2. Classification 2 : Groupe Placebo........................................................................51 3. Classification 3 : Groupe test ...............................................................................52 4. Analyse biostatistique des résultats .....................................................................53

B. ABSENCE DE RESULTATS ...........................................................................................55 C. RESULTATS TEST PAR TEST .......................................................................................57 D. REEVALUATION A J+7 ...............................................................................................59

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IV. DISCUSSION..............................................................................................................61

A. CONCERNANT LES PERTURBATIONS FONCTIONNELLES ..........................................62 1. Les problèmes dentaires ........................................................................................62 2. Les troubles parasympathiques.............................................................................62 3. Les céphalées .........................................................................................................63 4. La dure-mère ..........................................................................................................63

B. CONCERNANT L’EFFET PLACEBO..............................................................................64 C. CONCERNANT LES AFFERENCES DU SYSTEME POSTURAL .......................................66

1. L’extéroception visuelle.........................................................................................66 2. L’extéroception plantaire ......................................................................................67 3. La proprioception ..................................................................................................68

D. CONCERNANT LES EFFERENCES DU SYSTEME POSTURAL .......................................69 1. Le réflexe nucal ......................................................................................................69 2. Le tonus musculaire global ...................................................................................70

E. CONCERNANT L’OSTEOPATHIE PRATIQUE ................................................................71 1. La région sous-occipitale comme témoin privilégié d’une perturbation

fonctionnelle ..................................................................................................................71 2. L’OAA et son rôle de réinitialisation globale du tonus musculaire ...................73

V. CONCLUSION.............................................................................................................77

VI. REFERENCES ...........................................................................................................81

VII. ANNEXES ....................................................................................................................1

A. ANNEXE 1 : QUESTIONNAIRE PRELIMINAIRE .............................................................1 B. ANNEXE 2 : QUESTIONNAIRE DE REEVALUATION A J+7 ...........................................9 C. ANNEXE 3 : RÉSULTATS ............................................................................................13

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RESUME

Cette étude repose sur une recherche exploratoire pour appréhender le retentissement corporel d'un traitement

ostéopathique de l'articulation Occipito-Atlanto-Axoidienne ou OAA.

Le déroulement de cette étude suit une hiérarchie classique. Cependant, elle attache une importance particulière

à la présentation et à l'explication des nombreux liens qui unissent l'OAA au reste du corps. Ainsi, la recherche,

bien qu'exploratoire, sera réalisée dans un cadre préétabli de fonctionnement corporel.

Une fois ce cadre défini, trois groupes sont constitués parmi les 40 participants volontaires. Tous les participants

remplissent une enquête préalable permettant de définir avec précision leur état général ainsi que les troubles

pouvant les affecter.

Ces trois groupes subissent ensuite deux séries de tests permettant de juger de l'efficacité de leurs stratégies

d'équilibrations :

- En dehors de tout traitement pour le groupe témoin,

- Après une technique placebo pour le groupe placebo,

– Après un traitement ostéopathique de l'OAA pour le groupe test.

Un questionnaire de réévaluation 7 jours plus tard est réalisé par les groupes test et placebo afin de juger de

l'efficacité de l'effet placebo.

Les résultats permettent de situer l'OAA comme une région charnière entre le système nerveux central et

l'organisation spatiale d'un individu. Ils confirment l'efficacité réelle de l'ostéopathie et son rôle de régulation

(proprioceptive principalement). Ils nous permettent également de reconsidérer le rôle de l'OAA tant dans la

prise en charge diagnostique que thérapeutique. Enfin, ils apportent une preuve de la complémentarité

d'application de l'ostéopathie aux soins optique, orthoptique, dentaire et orthodentaire, kinésithérapique

(rééducation) et podologique.

ABSTRACT

This study is based on an exploratory research to apprehend the physical impact of an osteopathic treatment of

the Occipito- Atlanto- Axoidienne (“OAA”) articulation.

This study follows a classic hierarchy. However, a particular importance is given to the presentation and

explanation of the numerous links joining the OAA to the rest of the body. Thus, the research – even if exploratory

– is done in compliance with preconceived settings of the body way of functioning.

After these settings are defined, three groups are made up among the 40 volunteers. All participants fill in a

preliminary survey which enables to define precisely their general state of health as well as disorders they may

suffer from.

The three groups then take a succession of two tests aiming at judging the efficiency of their equilibration

strategies:

- After no treatment for the control group,

- After a placebo technique for the placebo group,

- After an osteopathic treatment of the OAA for the test group.

7 days later, a reevaluation questionnaire is done by the two last groups in order to assess the efficiency of the

placebo effect.

The results enable to place the OAA as a pivotal region between the central nervous system and the spacial

organization of an individual. They confirm the real efficiency of osteopathy and its regulation role (mainly

proprioceptive). They also enable to reconsider the OAA role in the diagnostic as much as in therapeutic

approaches. Finally, these results prove the point of the complementarity of application of osteopathy with

optical, orthoptical, dental, orthodental, physiotherapeutic (re-education) and podiatric cares.

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