Manipulative Therapy in Rehabilitation Locomotor System 3rd Edition

I ordered this book used, and was absolutely delighted to find it is autographed by the wonderful Karel Lewitt himself! If I don't look at the writing too closely, I could almost imagine he autographed it to me. I have read many other pieces by Karel, and if I could choose to learn under just one physician, it would be him. I am saddened because I did not get a chance to meet him and thank him in person before his death. However, I am working my way through this text, albeit slowly. Why? I keep re-reading chapters because each is so rich with insight and information, and I constantly find myself amazed by what he managed to learn through his lifetime of patient care and research, putting together the many disparate approaches to human locomotor dysfunction into one of the most complete whole-body views known today. Karel connects things in ways not seen anywhere else I'm aware of, with his inimitable method of identifying correlations (or causations) between dysfunction, pain, pathology, and degeneration. As in his other works, Karel has this almost avuncular way of expressing his observations, including when uncertainty is present, and maintains the most genuine sort of humility of the type that characterizes history's most brilliant and insightful minds. He gives generous credit to many, including the more well known contemporaries such as Janda and Kolar. He readily identifies how his current (at the time of this book) level of understanding is the result of years of incremental understanding built upon the foundation(s) of previous "Aha, we've figured it all out!" models, the exception being, well, no model was complete. The sort of knowledge hierarchy he begins the book starts with his learning manual therapy and the manipulation of joints since joint pain and dysfunction are common, followed by the realization that joints are controlled by muscles, and dysfunction in muscles leads to joint problems. "Muscle Energy" techniques were learned to try and correct muscle dysfunction by the right mix of activation and relaxation as needed. Trigger points were then found as factors behind most muscle dysfunction, yet later it became obvious that trigger points and joint dysfunction did not happen haphazardly, so his research progressed into those particular why's, leading to the discovery of the body's deep stabilization systems involving either end of the spine, the eyes, feet, etc, and so on. In reverse order, his final theory--self-admittedly incomplete--was if the source of instability could be found and corrected, the subsequent symptomatic problems (those we perceive) such as pain, would automatically resolve. I have noticed this in my practice, admittedly haphazardly due to my own intellectual limits, a startling example being how resolving a right foot problem caused the patient's left shoulder spasms to immediately resolve!Every time I read this book, I want to take more notes. It is like touring an incredible museum: Each time I visit, though having last left thinking there is nothing more to see, more revelations happen, making each trip between the covers fascinating and exciting. It is my hope to one day better integrate his understanding into my own thinking. The only drawbacks, which are quite conditional in my opinion, is the bulk of the research cited is quite old. I say that as an observation more than a criticism because, frankly, much modern research is rather narrow--by design--and focused on pharmacological, surgical, or other narrowly channeled therapeutic approaches aiming at the proverbial "tree" versus the big picture approach Lewitt has that, unfortunately, is not taught, and rarely learned by clinicians of any type today.

This text, published initially in 1985, and available in three editions, is, in my professional opinion, the most useful text on the subject of spinal locomotor dysfunction and its sequelae of any ever available. I am dismayed to find that it is no longer published, as the information contained within is just as useful and relevant today as it was twenty years ago. Dr. Lewit amassed an enormous amount of skill and knowledge during his many years of practice in Czechoslovakia, and he patiently shares much of that knowledge throughout this text. The book follows a logical progression, beginning with a description of the various types of locomotor dysfunction, then progressing to examination and therapeutics (manual treatment). He then provides a lengthy chapter dealing with detailed evaluation and differential diagnosis of many conditions often associated with or caused by locomotor dysfunction, as well as his experiences on important modifications or contraindications when warranted. Unlike many contemporary texts, Dr. Lewit's text reads as a detailed guide. He patiently takes the reader through each topic, providing all of the essential bits-and-pieces along the way. I've rarely encountered a text that is this thorough in its coverage. I still refer to this text regularly, though my copy is extensively highlighted, marked, and well-read. His sections on the evaluation and differential considerations of cervical torticollis, disturbances of equilibrium, and pseudoradicular syndromes are unrivaled -- better than any text I've yet read in chiropractic, neurology, or orthopedics. This is also the only text I've yet read that demonstrates the proper use and differential diagnosis of conditions causing an abnormal Hautant's test (it's for a lot more than vertibrobasilar ischemia). Dr. Lewit practiced with two other notable Czech physicians: Dr.s Jan Jirout and Vladimir Janda. These three men have published extensively since the 1950s on topics related to manual medicine, and their expertise, though not in name, is also evident in this book. In my professional opinion, this book is worth its weight in gold for the information it contains, especially now that it's no longer published. Of all the texts I own on locomotor dysfunction, this is the best.

Every chapter is a complete book, there is not a single wasted word or irrelevant concept. This text is priceless, it is my most prized book among several thousand on my shelf. I use it everyday still after 15 years in practice, Karel Lewit IS irreplaceable.