Term "Prague school"

PhysiotherapyThis term is used for methodics or access in physiotherapy, by which physiotherapy was differed in Czechoslovakia from the rest of the world.

Founders of the so called “Prague school” with a new way of thinking, modern and functional diagnosis and founders of the myoskeletal medicine in the czech republic are doctors:

The general difference in how the patients are viewed, is that the founders of the “Prague school” viewed the patients from a functional point of view. They are not focusing on a structural disorder, but instead focus on a functional problem of the patient which is dependant on the controlled movement by the central nervous system. Favorite saying of doctor Lewit is “We don’t heal x-ray images, but patients”. He also compares it to function of the car: “The car won’t run it has broken shaft, it’s a material damage. And the car also won’t run if it has incorrectly timed ignition, thats a functional problem”. In computer terminology it can be compared to when there’s defective structure like defective hardware and defective function of the organ is basically software defect.

Orthopedics, neurology and rheumatology (main disciplines dealing with treatment of the musculoskeletal system) don’t have very functional conception to this day. Doctor from these disciplines will always find a degenerative change, damaged tissues, inflammation…, which he starts to treat according to his qualification unlike from a functional view of a physiotherapist.

That being said, people who suffer from back pain, are not being examined by the physiotherapist just based on x-ray images or MRI (magnetic resonance) or CT scans (computed tomography), but he has to be able to evaluate to what rate do the patients have problem and in what area are they held back. But at the same time often times do these scans and diagnostic methods show how serious the damage of the structure is (for example Spinal disc herniation), but the patient can feel pain, that does not really respond to such serious extent, or the patient can be completely without pain.

BEGINNING OF A NEW APPROACH

Beginning of the changed view on the patients and their condition started in the period around second world war. Where some of the mentioned doctors had the chance to work on a Neurological clinic of the Dr. Henner in the Kateřinská street in Prague. The biggest expansion of the theoretical knowledge and work with patients started with the end of the war.

Before the new functional concept , the patient was only viewed as a “machine” which sometimes gets defective parts”, which has to be treated pharmacologically (inflammation, etc…) or by operation (spinal disc herniation, degenerative changes…). That lasted until the functional way of thinking allowed a bigger expansion of the rehabilitation, combination of pharmacology, physical treatment and new therapeutic techniques in physiotherapy.

WHAT IS BLOCKING THE EXPANSION OF THE FUNCTIONAL VIEW?

The reason why doctors still view the pain of the patient only as a structural problem is easily “justifiable”. Party it is because the tuition on the medical faculties is teaching the young medics in a cartesian view (scientific approach, possibility of factual explanation) and at the same time the expansion of technology allows better and more detailed diagnosis. Pharmacological companies have an economical interest in treating the patients, but not healing them. Medical research is sponsored by the companies which produce or sell the drugs or machines. Therefore there is no one who wants to treat patients pain in short time with manipulative treatment, noninvasive method, change of lifestyle, active exercising, sport etc…

Physiotherapist who is educated in the functional point of view, doesn’t just look on the painful area, but takes in mind every possible aspects in more distant places as well. For example during painful shoulder he also evaluates the condition of the cervical spine, shoulder blades and ribs, but also position of the pelvis, diaphragm, condition of the feet… He will also examine how the patient/client uses their body during the day. Which sports do they practice if any, and how do they compensate the working stereotype. From childhood people sit at school, then at work, they drive cars around, use elevators etc… they have minimal movement activity. With this deficit is connected also functional disorder of the musculoskeletal system. Therapy then depends on insufficient function of the found deviations, client then exercises also breathing during painful shoulder joint, core stability, feet… this approach is depending on thorough examination and complex knowledge of the related disorders and functions of the musculoskeletal system.



Author:
Mgr. Iva Bílková, FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Internet, gained informations during studies by prof. Prof. Lewit, Doc. Véle, Prof. Janda a Prof. Vojta

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