The Prague School of Rehabilitation

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This issue contains abstracts from the meeting of the Czech and Slovak Society for Myoskeletal Medicine held last year on ‘The Stabilizing System of the Spine and Comprehensive Modern Approaches to Back Pain’: that special congress was arranged in recognition of the continuing contribution to the Prague School made by Professor Karel Lewit, and in his honor. And this issue also contains a new piece of research from him and Magdalena Lepsikova. The Prague School of Rehabilitation is a model based upon an understanding of the neurological organization of the nervous system. It has its roots in the Medical Faculty of Prague’s Charles University and began to emerge in the 1950s under Professor Henner, who introduced a ‘functional neurological examination’. Three neurologists in the same department continued this work and, perhaps due to the relative isolation imposed due to the Cold War of the time, their methods were allowed to thrive in traditional skills of empirical science and experiential learning, which, in the musculoskeletal disciplines, meant that a model was borne from little more than observation, palpation, and intuition. In the 1950s, Czech neurologist Vladimir Janda noted that, in chronic pain patients, there was a tendency for the tone of certain muscles to increase, and for others to decrease, leading to a series of predictable postural syndromes. 1–3 He described such entities as the lower crossed syndrome (LCS) (hypertonic thoracolumbar erector spinae, iliopsoas, and rectus femoris, along with hypotonic abdominal muscles and glutei leading to an increased lumbar lordosis) and suggested it to be an adaptation to the demands imposed upon the musculoskeletal system (MS) – as it is the posture of the deconditioned and of the office worker. Janda probably made his greatest contribution with his realization that there was concurrent movement dysfunction in such cases as the LCS, perhaps due to such aberrant changes in muscle dominance. His colleague, Karel Lewit, originally concerned himself with the assessment of the movement of joints and with passive interventions, developing many of the soft tissue and mobilization techniques subsequently adopted and taught around the world. 4 While retaining such techniques, Lewit also aligned himself with Janda’s concepts, expanding the field by observing and palpating gross and local tissue tone; and developing further active treatment techniques as the ‘patient’s muscles always do a better job than those of the best therapist’. These two great pioneers took manual medicine to a new level: in addition to their own concepts and research, they studied components of other professional teachings of the day (such as osteopathy and chiropractic) and began to build a broad model of MS pain: and so the model for the Prague School was seeded. The skill of observation was perhaps the most influential tool upon which they relied. Observing movement patterns in a body-wide situation led to an understanding of the influence along the entire kinematic chain. Lewit described the importance of identifying the ‘key link’ finding and treating the major mechanical failing in the kinematic chain for a given movement, irrespective of the pain site. 4 He notes