Theoretical foundations

All theo­re­tical foun­da­tions of causal therapy of the postural and muscu­los­ke­letal system are known in medi­cine and gene­rally acces­sible. First, we give here a general presen­ta­tion of the basics. Later, these will be described sepa­ra­tely for doctors in this field and for medium-sized medical staff with a theory of motion (physio­the­ra­pists and physical therapy instruc­tors) and without a theory of motion (masseurs).

Theory from textbooks

1. Introduction

I have not invented anything new, I have only linked the exis­ting know­ledge in medi­cine differ­ently. I have tried to econo­mize my work as a physio­the­ra­pist and treat pati­ents more effec­tively, and this with simple means. I as a physio­the­ra­pist have my hands, I still have an elec­tric appa­ratus, a couch. I have to live with this and work as effec­tively as possible. So the most important thing is the results of the exami­na­tion, the diagnosis.

When a patient comes to me, I always ask myself first: what is the motive of nature that the body has to defend itself in this way and react just like this? Then I worked out a therapy for a specific syndrome. The most important thing is to reco­gnize that the loca­tion of complaints often does not explain the cause.

Quite typical – the mouse arm. It hurts in the arm or upper back, it is treated there, but the cause is the wrist. Or for example, often you have discom­fort in the lower back: you give massage, manual therapy, physio­the­rapy. Who thinks about the foot? The patient goes home healthy. Alle­gedly. But after a quarter of a year, he comes back. For example, the shoulder hurts, so the doctor writes down some­thing for the shoulder. Family doctors, general prac­ti­tio­ners in Germany have 15 hours of physio­the­rapy in their trai­ning. Often they don’t see the cause-and-effect (causal) connec­tion.

If you know this connec­tion and have a certain weapon for a certain symptom, and if you work through ever­y­thing in the right order, then you need much fewer treat­ments and the therapy becomes noti­ce­ably more and more effec­tive. Today, I treat up to 60 pati­ents a day. But what I do also has a lot to do with experience.

For example, I have a proce­dure in manual therapy where you can’t do any harm. This is a very gentle muscle treat­ment. That’s why, in prin­ciple, I don’t need an MRI or an X‑ray. The only thing that can happen: nothing happens. Because it is a pure muscle treatment.

So, I have diffe­rent methods for diagnosis and therapy, and I have a diffe­rent approach to how I approach illness or, better yet, the problem. The most important thing is to reco­gnize how the problem arose.

I have looked after hand­ball players as a masseur and have seen how the injury happened. So I was able to develop a plan for the therapy rela­tively quickly. Now someone comes into my office with an injury, and suddenly I needed much more time for the treat­ment of the shoulder. Because I didn’t see how it happened. That’s why I’ve made it a habit to ask ques­tions first to find out how it all happened. How did the violence get on the body? One of the first ques­tions I always ask the patient is what he is employed as.

An example: car acci­dent. Trauma to the cervical spine. Where were you sitting in the car? On the driver’s side or the passenger side? Where was the seat belt? Did the blow come from behind you, from the side, or from the front? At what speed did the blow come? Imme­dia­tely some­thing about this. We take a hammer and hit our own thumb. If we feel pain imme­dia­tely, the hammer blow was not very strong. If we hit it really hard, nothing hurts at the moment, but after a few minutes the pain starts. If there is pain right away in the rear-end colli­sion, then that is better. If the pain comes only the next day, then it was greater violence, and it also takes longer in therapy. – Have you ever thought about some­thing like that? But it is like this.

Now a brief intro­duc­tion to “Causal therapy of the postural and muscu­los­ke­letal system” from a diffe­rent angle, applied biome­cha­nics.

Isaac Newton estab­lished three laws of mecha­nics. Force and coun­ter­force are equal to zero. Bodies attract each other. And the third is: a force must be so great that it over­comes inertia to set a body in motion. The body has 658 muscles that move the body. And each muscle is made up of a diffe­rent number of fibers for specific tasks.

We simplify the whole thing by saying that we have a fiber that constantly works against the earth’s gravity and a fiber that makes the move­ment in a joint. Many dise­ases of the postural and muscu­los­ke­letal system with over­load or under­load of the muscu­la­ture and thus an over­load or under­load of a joint are asso­ciated with an uneco­nomic beha­vior of the body against the force of gravity of the earth.

Normally, it is known from manual therapy, the body is perfectly straight: imagi­nary line – middle ear, shoulder, trochantor major and outer ankle. If this middle posi­tion of the body is displaced, it is neces­sary to constantly work differ­ently, with other muscles against the gravity of the earth at a diffe­rent angle. This leads to over­load of the muscu­la­ture and thus to problems.

The goal of causal therapy is to return the body to a middle posi­tion so that one can hold the body upright with as little force as possible.

Many dise­ases are gene­rally trained in the muscles, it is known: Gym, yoga. And no conside­ra­tion is given speci­fi­cally to one of the two crucial muscle fibers. Namely, the fiber that works against the force of gravity of the earth, and the fiber that makes the movement.

In prin­ciple, I distin­guish two types of dise­ases in the postural and muscu­los­ke­letal system: dise­ases or complaints that increase at rest – long sitting, long stan­ding, after slee­ping. There, it is to be expected that there is a weak­ness of the holding muscle fiber. And then there are complaints that incre­asingly occur during move­ment. And these are usually dise­ases or changes that are due to a weak­ness of the loco­motor muscle fiber.

For the trai­ning of the holding muscle fiber I recom­mend the exer­cises accor­ding to Dr. Smíšek. And for ever­y­thing that increases with pain during move­ment, I recom­mend move­ment therapy as a whole.

In addi­tion, I am of the opinion that such syndromes arise in so-called chains. That is, effects from the foot can go through chains up to the head. Whereby the spiral chain should be paid more atten­tion than the straight chain, because our life works in the spiral. We walk in the spiral, we move in the spiral. And there stabi­liza­tion is more important than straight stabilization.

The spiral stabi­liza­tion is prefer­ably trained by Dr. Smíšek. The exer­cises are easy to learn under guidance and then have to be continued inde­pendently. It is important for me to reco­gnize which spiral is disturbed and I ask myself what it is disturbed by. If the change of the spiral or the change of the move­ment that is not correct leads to a centra­liza­tion problem in the joint, I always treat the joint first and then the spiral.

Treat­ment direc­tion or treat­ment notes for causal therapy:

  1. Pain manage­ment. If pain is present, the person gets into a forced posture and the body can no longer be moved ideally. The most typical example: forced posture in sciatica.
  2. Inflamm­a­tion is always accom­pa­nied by swel­ling, even in the joint. The water must go

Very important at the begin­ning: pain treat­ment and treat­ment of swel­ling, which is a sign of inflamm­a­tion. So, the inflamm­a­tion and swel­ling must go away. That’s the second one.

The third is then: to return the body to the muscle- and move­ment balance. If it works. Or, if it is not possible, to approach the goal. Ortho­pedic aids such as insoles, ortho­tics and the like also help me in this, for example to move the center of the body. Since I believe that early mobi­liza­tion is much more effec­tive than prolonged immo­bi­liza­tion, I am also in favor of ortho­pedic devices that help me keep the spiral motion stable in the joint.

Now we come to the pain.

2. Pain

Physical pain

What is pain? When I became a physio­the­ra­pist 40 years ago, pain was still learned as a message of damage from the body to the head. Today we know, with pain some­thing changes to the disad­van­tage of the body.

An example. We cut our finger, a scar remains. If it were a damage message, it would hurt for a life­time. But it doesn’t. It heals and the pain is gone. Unless you have stored it in your head, in your memory for pain.

And we also know some­thing else today. Pain is also stored in the connec­tive tissue – we don’t yet know exactly how this works. Since this is known, fascia tech­ni­ques have taken a huge upswing.

One of the most important treat­ment goals is to treat pain imme­dia­tely. So don’t go without pain­kil­lers for long if you have pain for a long time. Unfort­u­na­tely, this is bad for us physio­the­ra­pists. The patient takes ibuprofen, comes to us and can’t tell exactly where it hurts. That is diffi­cult. That’s why I say, if possible, don’t take pain­kil­lers before the first treat­ment. Because the therapy becomes more diffi­cult for us physio­the­ra­pists. Ortho­pe­dists don’t like that either.

People have back pain, they get a referral to the ortho­pe­dist, the appoint­ment is in four weeks. What do they do for that long? They take ibuprofen. And then they can no longer tell the ortho­pe­dist exactly where the pain is coming from. Then they send the patient for an X‑ray and, if neces­sary, an MRI to be sure. This costs money and time. If the pati­ents came without taking pain­kil­lers, it would be easier. That’s why I always treat as quickly as possible, at least the first treat­ment, before they take these very pain­kil­lers.

Pain quality

When a person comes to me with pain, I always ask about the quality of the pain. Some doctors do a scale from 1 to 10. Zero – no pain, 10 – unbe­arable, leads to suicide. Then you ask the patient, where would you rank your pain? The answer: 7 to 9. – This method has not really proven itself in prac­tice.

I ask the patient, how high is the suffe­ring pres­sure caused by the pain? There are people who have mild pain for 20 years, but go to work with it. And then there are people who have a little some­thing, the pain is not so bad, but the suffe­ring pres­sure is enormous. That’s why I always ask how the patient feels his pain.

On the quality of pain. Example – the head. Do you have the feeling that the head is burs­ting? Or is the pain brut­ally stab­bing? If you, when you have pain in your knee or joint, feel it kind of full and feel a kind of pres­sure, it’s often a sign that what’s going on is accom­pa­nied by inflamm­a­tion and that the vege­ta­tive system is playing a role. However, if it is brut­ally stab­bing, the problem is often directly in the joint. If the patient has a thick knee, I always treat also vege­ta­tively and slightly in the back. Because that’s when it helps. When the head is fat, I always treat also the Scalini muscle. It contains vege­ta­tive fibers, sympa­thetic fibers. I see a lot of my colle­agues in the profes­sion massa­ging the upper back, but they forget about the scalini and don’t do it at all.

Pain and swelling must go

Example – a thick foot after twis­ting. What’s there a miracle remedy for first aid? When­ever some­thing is thick in the joint, we remem­bered an old home remedy. Curd! Curd is anti-inflamm­a­tory, the swel­ling decreases. It helps to remove the water faster, it has a lymphatic effect and cools a little. Is also done in compe­ti­tive sports again so. – The water must go!

If someone twisted foot, I don’t give a bandage or support. I want the foot to move imme­dia­tely. The curd is simply wrapped with a cloth so that it does not fall off. No compress, just wet curd. When this happens to an athlete, I still put dime­thyl sulfide oxide on the spot at the begin­ning. After that, 20 m next to my prac­tice is a shoe­maker, he glues a wedge under the shoe. This raises the outer edge of the foot a little, the pain is imme­dia­tely less. For 30 days I always do this. The move­ment in the foot also helps that the water is removed faster. The muscu­la­ture do not become weak. And that makes the whole therapy go faster. But the pain must go! Other­wise it’s really bad. – It’s actually not hard at all, right?

I once made an expe­ri­ment. I treated ten people accor­ding to the classic method, i.e. the foot with support (foot bandage), pain­kil­lers and rest. How long did it take for the people to get back on their feet? As a rule, it took a month. Then I treated ten people accor­ding to my method: move imme­dia­tely and do some­thing for pain. – 14 days! That’s the way it’s done again today in sports medi­cine.

I was once asked why osteo­paths are so popular. More and more people in Germany are tired of tablets. They don’t want so much chemistry anymore, it ruins their stomach and makes them addicted. And that’s when people remember these old, simple home reme­dies. That is also cheap. This foot bandage, the simple one, costs 70 € in Germany. Quark – 58 cents and the wedge – 7 €. And it goes faster!

Once again. If the pain is not stab­bing, but diffuse, I also always try a little to influence the vege­ta­tive system. Top at the head, upper extre­mi­ties, scalini, ganglion stel­latum, from TH1 to TH9, boun­dary cord of the sympa­thetic nervous system, lower extre­mi­ties, sacrum and pelvis. This helps a little with the therapy.

If one has a pain for a longer time, then the connec­tive tissue changes and main­tains the pain. This also changes the beha­vior of the muscu­la­ture. This circle, called Circulus vitiosus, is known. If I manage to break this circle or that it does not arise at all, I have already gained a lot. That is one of the reasons why I say: treat quickly or promptly.

And what about ice, for example? Ice blocks nerves, that’s good. Then people always say, “Oh, how can you put cold on it for scia­tica? My family doctor says put heat on it, a pillow in the back. And you come with ice! Where did you learn?” – Then you have also to explain this to the patient a little bit.

Further, I then try, espe­ci­ally in the postural and muscu­los­ke­letal system, to bring the body into a posi­tion where the patient has less discom­fort (pain). If I find that there are posi­tions where the patient has less pain, I often also have the oppor­tu­nity to help the patient. If funda­men­tally nothing changes with pain with all move­ments, then it is tight, then it can be some­thing else. Here also help tests where you can directly provoke the pain, e.g. the Lasègue test (for scia­tica – stret­ched leg up).

There is a study that says: if a person has pain over the course of 10 days, the pain is stored in the pain memory.

Now we come to the movement.

3. Movement

Due to changes in the work envi­ron­ment, one-sided and repe­ti­tive move­ments occur more and more frequently. Various dise­ases of the postural and muscu­los­ke­letal system result from the reduced variety of movements.

In each joint we have two types of move­ment. We have a rota­tional compo­nent and at the same time a trans­la­tional move­ment. The rota­tion is not the problem, the trans­la­tion is the problem.

We do not want to make it too compli­cated. We have in the joint once a rota­tion in both direc­tions and a trans­la­tion in both direc­tions. And the problem is not the rota­tional move­ment, but when the joint moves in a straight line (trans­la­tional). There are muscles around the joint, and they have either a shorter or a longer distance to travel. So some­thing changes in the biome­cha­nical system of the joint. The ideal would be – just go back, and the problem is gone.

But if a person constantly makes one and the same move­ment, e.g. with the computer mouse 3,000 times a day, then the muscles develop differ­ently, and then the muscle balance also shifts, which leads (can lead) to pain. Then, if there is pain, the joint is set with manual therapy, but after three days or three weeks the patient comes back with his problem.

Ther­e­fore, muscle treat­ment is always included after joint setting. However, this requires the patient’s willing­ness and coope­ra­tion. This is some­times not easy because the patient’s insight is not there. Massage is much more plea­sant. A doctor could prescribe it all day long…

Has that been so under­stan­dable for now?

4. Consequences, change of treatment concept, prerequisites for therapy 

At this point we inter­rupt here the expl­ana­tions to the theo­re­tical bases of the causal therapy of the posture and move­ment appa­ratus. If we compare once the chapter of the theo­re­tical bases described here with the human being, it corre­sponds appro­xi­m­ately to the skeleton. The entire theo­re­tical foun­da­tions of the therapy are curr­ently being compiled in an e‑book, which will be published shortly.

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