Spring 2009 • Vol. 22 • No. 1
Influence of Czech Techniques: A Historical Perspective
Ken Crenshaw, ATC, CSCS, Head Athletic Trainer, Arizona Diamondbacks; Dr. Craig Liebenson, DC, LA Sports and Spine
As sports medicine becomes in¬creasingly specialized, athletic trainers entrusted with the care of Major League Baseball (MLB) players constantly work to stay on the cutting edge of prevention, treatment and rehabilitation. Surprisingly, the Czech Republic, a country not known for base¬ball, has a rich history of integrated sports medicine approaches and methodologies helpful in rehabilitating elite athletes. The exposure of Czech methodologies has influenced many MLB athletic trainers.
History of Czech Techniques
The emergence of Czech ideas within the United States is a direct result of the efforts of renowned practitioner Craig Liebenson, DC, owner of the LA Sports and Spine in Los Angeles. Several MLB teams are now using forms of the Czech methodologies in their programs as this rehabilitation innovation continues to increase in popularity.
As these practitioners have influ-enced many sports health professionals, a genesis of hybrid and integrated pro¬grams has emerged within athletics. This line of thinking has resulted in an integra¬tion of functional methodology within sports medicine and has positively influ¬enced many elite athletes competing at the collegiate and professional levels.
Alternative Thinking
The Czech School of Manual Medicine has revolutionized the management of musculoskeletal pain (MSP). Beginning in the early 1950s, two neurologists, Karel Lewit and Vladimir Janda, took a keen interest in the rehabilitation of the motor system. They had a strong commitment to manual modalities and focused on a patient’s medical history and physical examinations. While west¬ern medicine became progressively high-tech, Lewit and Janda realized the merits of osteopathy, chiropractic and neuro-rehab (e.g., PNF) as vital compo¬nents of rehabilitation. Lewit focused on joint dysfunction and the passive osteoligamentous struc¬tures, while Janda’s research pioneered a new direction in the assessment of faulty movement patterns and muscle imbal¬ance. To frame the object of their care, they coined the term “functional pathol¬ogy of the motor system.” This was in contrast to medicine’s growing emphasis on structural pathology as identified by myelograms, X-rays, CT scans and MRIs.
In a nutshell, Janda was one of the first individuals to realize that muscle imbalances seen in neurological diseas¬es were present in orthopedic patients. For example, children with cerebral pal¬sy (CP) have spasticity of flexors, ad-ductors and internal rotators. Similarly, adults who suffer strokes have paralysis of extensors, abductors and external ro¬tators. To that end, Janda proposed that orthopedic or MSP patients typically experience the presence of a postural syndrome, which includes a predictable pattern of tight and inhibited muscles. Janda was the first to name these pos¬tural syndromes (upper and lower crossed syndromes) and was the first to document the muscles that tended to be¬come tight or inhibited.
Subsequently, Janda developed a treatment program incorporating post-inhibitory stretching techniques for the tight, postural muscles and sensory-motor balance training to facilitate and stabilize the inhibited chain of phasic muscles. Because sedentary lifestyles serve as the main promulgator of these MSP syn¬dromes, reactivation through activity, such as increasing daily walking and reducing prolonged repetitive strain as¬sociated with excessive sitting postures, were recommended as preventive options.
Concurrent with Janda’s efforts to focus rehab on the quality of movement (e.g., coordination, balance, motor con¬trol) rather than the quantity (e.g., strength, sets, reps, resistance), Lewit innovated new and gentler forms of manipulation. He defined the source of restricted mobil¬ity as a “pathological barrier.” Next, he extended this barrier concept from joints to other mobile structures such as muscles, fascia and even skin. Lewit refined meth¬ods from osteopathy and physical therapy making them more physiological. For in-stance, he showed how both respiratory and visual synkinesis could be utilized to enhance the “release” of tissue tension at the barrier.
A third Czech neurologist, Pavel Ko¬lar’s work represents a new and powerful window to the central nervous system’s control of movement. It is grounded in developmental kinesiology with integra¬tion into manual medicine and reflex lo¬comotion, whereas Janda’s emphasis was on how a sedentary environment pollutes our motor patterns and posture. These two complementary approaches give us an extremely powerful assessment and treatment approaches for subtle, motor control dysfunction that predisposes to MSP and injury. Kolar has now shown how to intervene at the deepest possible level to activate neurally driven, func¬tional muscle chains. Kolar has extended Vaclav Vojta’s (another Czech neurolo¬gist of Lewit and Janda’s generation) work from the neurologically impaired child to the healthy adult with MSP or the elite athlete. Kolar has shown how subtle neuro-motor deficits are genetically pre-determined in as many as 30% of our healthy population including elite ath¬letes. Using reflex techniques (Vojta’s Reflex Locomotion) developed for acti¬vating “hard-wired” normal patterns in CP children, Kolar has utilized these same methods to reboot the body’s stabil¬ity patterns in sedentary patients or ath¬letes suffering from overuse syndromes. This also helps speed recovery from in¬jury, rehabilitate function and enhance performance.
Expanding Techniques
The Czech School of Manual Medi¬cine’s influence on all modern research¬ers in the MSP field has been significant. Local, segmental treatments of individu¬al muscle and joint dysfunction is still a common treatment of chiropractors, massage therapists, physical therapists, athletic trainers and other manual thera¬pists. Thanks to the Czech clinicians, therapists are now beginning to look for the predictable patterns of dysfunction that link these individual tissues into functional chains. Janda’s work has had far-reaching diagnostic implications for focusing all clinicians on how to find the key chain of dysfunction. And, now due to Kolar’s applications that access the central nervous system program, opti¬mal movement patterns are within the grasp of every clinician or therapist.
Acknowledgement
I would personally like to acknowledge Dr. Liebenson’s help in writing the his¬tory involved in this article and also thank him for opening my mind to Czech ideas.
.JPG)
