You hold an international certificate in Mechanical Diagnosis and Therapy. Could you describe what it is all about?
It is a therapy based on the Australian physiotherapist Robin McKenzie, who came up with a groundbreaking technique discovered by accident in the 1960s. Mr Smith visited his surgery with right back pain that spread to his buttock, thigh and knee. He received adequate treatment at that time, but his condition did not improve. He had difficulty standing upright, could bend forward but could not bend backwards. Dr. McKenzie advised him to go into the room and lie on his stomach on the recliner, but it remained elevated at the upper end from the previous patient. Mr Smith lay face down, his back significantly arched. When Dr. McKenzie returned he found him lying in what was at the time considered to be the most injurious position and became very concerned. But, when he asked the patient how he was feeling, he said the best he had felt for three weeks. All pain in the lower limb had disappeared and moved to the central part of the back. He found that he could bend backwards without feeling severe pain. When Mr Smith was lifted off the rehabilitation couch he was able to stand upright, his improvement persisted and the limb pain did not reappear. Based on this finding, Robin McKenzie began to develop an entire technique of mechanical diagnosis and therapy that was quite different from all previous physiotherapy techniques. In the 1960s and 1970s he found that the same results could be achieved in patients with problems in the cervical spine or thoracic spine and later extended the therapy to peripheral joints.
What do you do with the patient during MDT, how does it work in practice?
It depends on what problem the patient comes in with. First I take a detailed history, which focuses on behavior and the presence of symptoms. For example, if the patient has a cervical spine problem, I find out what movements produce pain, in which positions the pain worsens, in which positions the pain decreases, how the pain changes during the day... And depending on where the problem is, I direct the therapy. But it doesn't mean that when a patient comes in with shoulder pain that I only look at the shoulder. I examine the whole limb, I look at the posture and based on repetitive movements I get an answer and I am able to categorize the problem. Very often the cause of the difficulty is elsewhere than its manifestation. When I examine the patient, I explain the mechanical cause of their problem and they are given exercises to repeat regularly throughout the day. A treatment that the patient himself can perform several times a day (e.g. 5-6 times) has a greater likelihood of success in the shortest possible time frame than a treatment that is only performed by the therapist about 1–2 times a week. In MDT, the emphasis is on the active involvement of patients in therapy. In principle, most patients can heal on their own if given the right information and the appropriate treatment tool. But at the same time, they must learn to minimize the risk of returning difficulties. This involves correcting posture and learning correct movement stereotypes. In MDT, I am basically able to select exercises for each individual tailored to their exact problem.
What problems is this method used for?
For acute back pain, full spine blockages, joint pain, difficulty bending due to stiffness, tingling limbs, headaches or abdominal pain. In any case, no matter how many exercises we set up for a person, an active approach is essential.
Another technique you’ve mastered is Dynamic Neuromuscular Stabilization (DNS), which you studied with Prof. Pavel Kolář. What exactly does it consist of?
DNS is based on developmental kinesiology. In the 1st year of our life, the activity of the nervous system develops. If it is ideal, it can be assumed that the development in terms of movement will also be ideal. And so, at the same time, non-ideal development during the first year of life is closely related to movement disorders in adulthood. The cause of the difficulties is usually muscle imbalance and overload, which arises due to poor function of the muscles of the spinal stabilization system. This consists of the diaphragm, abdominal muscles, pelvic floor muscles and spinal muscles. In this early period of a child's life, the muscular interactions that are to determine the rest of our lives are developed. However, disorders often occur as early as the first year or later due to overuse, overtraining, injury or incorrect movement habits. The DNS method does not focus on strengthening individual muscles, but uses specific exercises to influence their interplay. The aim of the exercises is primarily to stabilize the trunk by activating the deep stabilization system of the spine, which is also a prerequisite for good function of the limb muscles. The goal of DNS is not only to change the function of the muscles, but the whole nervous system setup. Thus, DNS can be used for posture defects in children and adults or scoliosis, as well as for back pain, orthopedic diseases or to improve the coordination of athletes.
How long does it take to get to an optimal state where one no longer has problems?
It takes some time before one even allows oneself to relax the abdominal cavity, which we almost all have retracted. Women and men. Nowadays we have learned unhealthy mechanisms, besides a tight abdomen, which are tight shoulder blades or buttocks. But that goes against what is natural and healthy for us. So the first important thing is to learn to relax the abdomen. It takes weeks to change the movement pattern.
I'll come back to the abdominal retraction. It's probably due to the current beauty cult. What can excessive abdominal tightening cause in the long run?
When we have a constantly retracted abdomen, the diaphragm is not in an ideal position, top type breathing occurs, the chest is in an inspiratory position and the neck muscles are overworked. If we breathe at a rate of 16 breaths per minute, there is a significant overload on the entire cervical spine. In order to stabilize the body, the spinal extensors become involved, which can cause further overloading of the back. Of the abdominal muscles, only the rectus abdominis then works, the oblique abdominis and transversus abdominis are not very involved. The consequence is greater instability of the trunk and susceptibility to blockages throughout the spine. So in general, having a retracted abdomen looks good, but it's not healthy.
You're also involved in the Dorn Method, can you give us some background on that?
It's another mechanical technique, it aligns the length of the limbs, it affects the position of the pelvis and therefore the whole spine. It is again a manual therapy that returns the individual vertebrae and joints to their natural position.
The other method you use is sensorimotor stimulation…
Sensorimotor stimulation is a technique that uses nerve receptors in joint capsules, muscles, tendons and ligaments (proprioceptors). Prof. MUDr. Vladimír Janda, DrSc. contributed very substantially to the development of sensorimotor stimulation (SMS) in our country. He described the connection between chronic ankle instability and chronic back pain based on impaired proprioception (deep sensitivity). When these receptors are stimulated, the muscles and muscle chains are activated so that correct posture and fixation of correct movement patterns occur. This method uses labile surfaces, balance sections or balls and is suitable for both children and adults.
Do you also practice the Ludmila Mojžíšová method, and in which cases is it useful?
For women with menstrual cycle disorders or women who cannot get pregnant. This method can also release various blockages in the spine and pelvic floor spasms. It also helps women who have headaches or migraines that may be associated with the menstrual cycle.
What form does this method take?
It is a full body examination, I look at the position of the pelvis, trunk and look at the tension of each muscle group. I look at the mobility of the spine, the lower limbs, the tension in the chest, the rib joints. Rib blockages are very closely related to tension in the pelvic region. After a detailed examination, I will then recommend specific exercises for the client to do at home.
We have not yet mentioned kinesio taping, which is now very popular especially among professional and amateur athletes. Does it also help in physiotherapy?
Kinesio taping is used as a supportive method in case of back pain, joint and shoulder injuries or other injuries. It is also popular with athletes to help stimulate or inhibit selected muscle groups. Once the knee, shoulder, back or ankle is overloaded, there is a decrease in blood flow. A properly applied tape (a special adhesive tape applied to a specific area of the body) will speed healing by allowing better blood and lymph flow, and therefore faster flushing of the acidic metabolites of inflammation that irritate the muscle.
Are the methods you use somehow age restricted or can they be used for all ages from children to the elderly?
These techniques are not age restricted in any way, they can be used for pretty much anyone. If there are no structural changes, there is always a chance to correct or at least improve the condition, even at an advanced age. If the appropriate therapy is chosen and the person has enough effort and will to exercise responsibly. Of course, for patients who are chronic, everything is much more difficult, but even they can be helped.
It is said that everyone has a sore thumb. But nowadays it is very fashionable to handle pain with analgesic drugs. How should a person know when it's time to see a physiotherapist?
You'll know when the pain stops. Each of us has a different level of tolerance to pain, but if there are difficulties that do not improve, but rather increase, it is necessary to seek professional help. Most pain, if it is a mechanical problem, goes away spontaneously. However, over time, recurrences are more frequent and take longer to heal. Then it is advisable to see a specialist. The sooner one comes, the quicker the problem is corrected.
If one does not address the cause of the difficulty and relies on medication for a long time, can the situation escalate into some abnormal condition even in the case of relatively common problems?
Absolutely. An acute problem becomes a chronic problem, more difficult to solve. If a problem cyclically returns, it is not a coincidence. It's a signal that you're doing something wrong and need to change it. It doesn't mean you need to start exercising intensively for hours. Most of the time all we need to do is change a little of our habits, such as correcting our sitting posture and proper chair alignment, and there can be a significant improvement.
Are there any new methods, devices or therapeutic aids in physiotherapy?
Czech physiotherapy is at a very good level. It is important to look at the human body as a whole, as a complex mechanism where everything is connected to everything else. The influence of our psyche on the body is also very important – there is talk of psychosomatic difficulties, and another important area is vertebrovisceral relations – the connection between the internal organs and the spine. For example, a prolonged blocked shoulder can cause irritation in the stomach. Each organ has its own typical pattern in the motor system – the so-called visceral pattern. It is possible to distinguish whether there is a malfunction of an organ or just a blockage. And long-term visceral difficulties have a complex effect on the behavior of our entire musculoskeletal system.
Thank you for the interview.