Preface on the Occasion of the 25th Anniversary

The current textbookMusculoskeletal Manual Medicine has,in terms of medical publishing, a long and interesting his-tory. Although this book has a new format, completelyreworked and reorganized, the original ideas presented25 years ago still hold true. To the surprise of many—bothwithin and outside the field—probably no other back paintreatment interventions have been studied as exhaustivelyin biomechanical studies and randomized clinical trials asmanual medicine procedures.

During the past 25 years, interest in the field has steadilyincreased, both on the part of the public and patients, andon the part of orthodox medicine. Manual medicine hasgone from having an “outsider” role to being a logical partof the armamentarium of today’s musculoskeletal physi-cian. Again, history is a good teacher.

In the mid 1970s, CT, MRI, SPECT, and PET scans capableof investigating structures and tissues potentially respon-sible for primary symptoms such as pain and altered struc-ture and function were not available to patients presentingwith musculoskeletal disorders. However, with the increas-ing interest in and fascination of applications of technologyin patient care, the physician’s hands as a diagnostic andtherapeutic tool were commonly neglected, particularly inthe assessment of such musculoskeletal disorders as so-called nonspecific or mechanical low back and neck pain.

In the late 1970s our attention was attracted by a smallgroup of Swiss physicians successfully using manual med-icine approaches, both diagnostically and therapeutically.We became students of the prominent Swiss rheumatolo-gist, Dr. Max Sutter, who taught us one-on-one how to useour hands to palpate the changes of different tissues in thehuman body such as the skin, subcutaneous tissues,muscles, and tendons. The principle idea was to try toidentify the anatomical structures and relationships re-sponsible for pain and altered function in a joint or spinalregion.

The first two authors, together with the orthopedicsurgeon Dr. Tomáš Drobný, set down their experiences ofthe nearly 3-year educational process in the first Germanedition ofManual Medicine: Diagnostics (Manuelle Medizin:Diagnostik), with a print run of a total of 10 copies of a bookbased on our own hand colored drawings, the starting pointof a long medical journey. Many of the original drawingsfrom this very first edition in 1980 are still used in thecurrent textbook, now redrawn and following a layoutthat was created, yes, with sophisticated publishing tech-nology. At that time we were already impressed by theseminal research papers and textbook on clinical bio-mechanics by Augustus White and Manohar Panjabi. These

two authors influenced immensely how we would learn tothink about and approach new research projects thatwould investigate principles of mechanisms and how theyrelate to clinical signs and symptoms. This resulted in awonderful friendship and thoughtful scientific collabora-tion, and nearly 50 papers in peer-reviewed journals.

Knowing the quality of Thieme Publishers, we presentedthem with our hand-made book for consideration. In 1983,Thieme Publishers courageously published a book which atthat time appeared to be quite an exotic project: the firstGerman edition of Manual Medicine: Diagnostics. We thinkthat this important decision served everyone well.

Soon after the first edition, and being educated withinthe framework of the rather young Swiss Medical Associa-tion for Manual Medicine, we visited well-established edu-cational institutions of osteopathic medicine in the USAthat already held university status, as well as those collegesof chiropractic accredited by the Swiss health system toeducate Swiss chiropractors. The close exposure and col-laboration with experts of osteopathic manual medicinesuch as Philip Greenman, Myron Beal, and Bob Ward, andfrom the chiropractic profession, Scott Haldeman, not onlyoffered us new dimensions and aspects of manual medicinebut also taught us to respect and collaborate equally withdoctors of osteopathic medicine and doctors of chiroprac-tic.

Wolfgang Gilliar, DO, currently Professor at the NewYork College of Osteopathic Medicine of the New YorkInstitute of Technology, translated the book, and it waspresented to the English-speaking market in 1984.

Following the experience gained from our exposure toosteopathy and chiropractic on the occasion of the 7thInternational Congress of the FIMM (International Federa-tion of Manual Medicine) in Zurich in 1983, we invited theleaders in their particular field to what is now known as theFischingen Conference. There, within 1 week, the commondenominators of manual medicine, osteopathy, and chiro-practic were openly and collegially discussed. We realizedthat many of the diagnostic and therapeutic approachesappear similar or deviate only slightly from each other—asfar as the biomechanical model is concerned—and theirapproach and applications may have been shaped, at leastin part, by their professional context and philosophy.

In the 1980s relationships between exponents ofmanualmedicine and classical orthodox medicine were somewhattense. In other words, traditional universities, at least inEurope, seemed rather reluctant to integrate the diagnosticand therapeutic aspects of manual medicine within theframework of what could be best medical practice. Around

VIIaus: Dvorák u.a., Muskuloskeletal Manual Medicine (ISBN 9783131382818) © 2008 Georg Thieme Verlag KG

the globe, the trend of and call for evidence-based ap-proaches became more important, not only in academicpractice but in medical practice altogether. In this regard,we received quite a strong message from one of the mostprominent and respected pioneers in spine research, Pro-fessor Alf Nachemson fromGötheborg, Sweden. After send-ing him the first edition of the English book for review, hisanswer was swift and to the point: “I will not read yourbook unless it has been scientifically proven.” Our firstreaction was quite human, but giving Dr. Nachmeson’scomments a second thought, we weremarkedly influencedby them, as was our further development. The first authorreturned from clinical practice and started his residency inneurology to obtain education and particularly scientifictools to investigate and fulfil Nachemson’s request. In thisrespect, the close collaboration with Manohar Panjabi andhis research team, as well as the opportunity to performcadaveric experiments in the highly sophisticated labora-tory of the Moris Müller Institute in Bern was a luckycoincidence to the advantage of the development of Mus-culoskeletal Manual Medicine, which further contributed toour personal improvement of understanding and clinicalskills. We realized, thanks to Nachemson’s hard lesson, thatclinical experience—while serving as a good startingpoint—is not enough, and actually carries a risk of beingled in the wrong direction.

The scientific approach, which we as authors of thecurrent book implemented in the framework of our think-ing, dominated our next steps with the intention to searchfor evidence of those phenomena which we felt by usingour hands for diagnosis and treatment. The exposure asactive members of the leading spine societies such as theInternational Society for the Study of the Lumbar Spine, theCervical Spine Research Society, and the Spine Society ofEurope, also influenced our development and, being con-fronted with spine surgery in particular, we learnt thelimits of conservative approach including those of manualmedicine. We respected the limits and, while understand-ing the great advantages of modern spine surgery, we dis-cussed and recommended surgical procedures to our pa-tients when necessary to reduce pain and improve func-tion.

In 1997 we completely reworked and restructured thebooks and invited three new editors to enhance and im-prove the fifth German Edition with their experience andexpertise.

In this form the book became a major educational toolwithin the Swiss Medical Association of Manual Medicine,one of the most successful and active medical associations

in Switzerland, which offers postgraduate teaching to doc-tors and physiotherapists in the field of musculoskeletalmanual medicine.

The current English edition, Musculoskeletal ManualMedicine, has been completely reworked and integratesthe newest aspects of clinical biomechanics, clinical prac-tice, and evidence-based approaches to diagnose and treatmusculoskeletal disorders conservatively, including thepreventive programs.

For this new book, we invited Wolfgang Gilliar, DO,meanwhile close friend and exponent of osteopathic med-icine and well-known not only in the USA but also inEurope, to be coauthor. Having translated our initial texts(Manual Medicine: Diagnostics and Manual Medicine: Ther-apy), being a physiatrist, and ever interested in furthering ameaningful understanding of principles and mechanisms,he developed his own personal approach and expertisefrom the start. His contribution to the new English editionhas been major and the editors are very thankful thatWolfgang accepted the invitation to help shape and signifi-cantly contribute to the current book.

As editors and authors, we are highly satisfied with theseveral editions in different languages, with the first andcurrent edition spanning 25 years. The new edition, whichnow has become an entirely new book, reflects our per-sonal development as physicians, and at the same time iswitness to the growing acceptance of this form of medicinewithin the medical community. We realize this brings withit the responsibilities we editors need to take into accountwhen presenting new teaching material.

Truly this book has become a “trans” book: transconti-nental and transdisciplinary, integrating neurology (JD),internal medicine (VD), physical medicine and rehabilita-tion (WG), rheumatology (WS), sports medicine (HS), andphysiotherapy (TT). With the invaluable input from all thecontributors, it is our sincere wish that the reader is stimu-lated to move beyond professional boundaries and look atthe “soul” of the topic at hand.

This may be a topic—hopefully with more research re-sults, ideally with its own new ideas and forms of inves-tigation— in a book in another 25 years from now.

Jirí DvorákVáclav DvorákWolfgang GilliarWerner SchneiderHans SpringThomas Tritschler

VIII

Preface

aus: Dvorák u.a., Muskuloskeletal Manual Medicine (ISBN 9783131382818) © 2008 Georg Thieme Verlag KG