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Professor Karel Lewit is the founder of Czech School of Manual Medicine, where the focus is based on the functional aspects of the motor system and its rehabilitation. His textbook on Manual Medicine has been published in 9 languages; the most recent book in English (Manipulative Therapy – Musculosceletal medicine, 4th ed, Churchill Livingstone) in 2009. Prof. Lewit’s work has been published in over 200 medical journals, books and videotapes. He is now retired but is still actively involved in teaching and consultingat the Rehabilitation Clinic of the 2nd Medical Faculty, Charles University in Prague, Czech Republic. |
Lecture
Session 2A
11.00-13.00 |
Lessons for the Future from a Lifetime’s Experience in Manual Medicine
In almost 90% of patients with pain of the locomotor system no pathological changes can be found. Pain is then called “non specific”, i.e. without diagnosis and therapy “symptomatic”. Clinical examination, however, reveals a great number of changes which are due to DYSFUNCTION. Dysfunction is as real as changes in structure, just as physiology is as scientific as anatomy. Clinical examination, is based on inspection and on palpation, which is considered “subjective” and therefore unscientific. At the same time dysfunction is even more complicated than structural pathology. Motor function is realized by programs in which all or most of the motor system takes part, it never results from the activity of one structure, but from the interplay of may structures. Therefore chain reactions are the rule. They concern muscles, joints, and soft tissues including visceral organs. This is most important as the methods of Musculosceletal (Manual) Medicine, address not structure, but function. There cannot be one method which addresses the numerous motor functions, but as the muscle is the effector of our will, the active role of the patient is most important. In the modern neuromuscular manipulative techniques the patient plays an increasingly active role. The newest techniques which address the deep stabilization system and relieve both muscle trigger points and joint movement restriction rely entirely on the patient’s activity.
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Workshop 4a
Session 3A/4A
14.30-18.00
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Spinal Stability Workshop
a. The Importance of the Foot in Spinal Stability
Normally forward inclination (not stooping) produces automatic toe flexion which prevents falling. In dysfunction of the foot rotation around its longitudinal axis is restricted due to muscle trigger points (MTrPs) and movement restriction of Lisfranc’s joint. Other signs of dysfunction are s sagging longitudinal arch during walking and asymmetrical plantar sensitivity. Clinically a chain reaction of MTrPs is found in the flexors and extensors of the legs, thighs, the trunk and the neck with a forward drawn posture. This can produce symptoms in all sections of the body. This chain is not always complete. By rhythmic forward inclination and returning to the neutral position toe flexion and extension normalizes foot dysfunction and the entire chain and the patient’s symptoms. An important diagnostic test shows increased tension of the muscles of the neck (and back) with the patient standing, but normal tension with the patient seated. The patient is instructed to train forward inclination with toe flexion regularly.
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