KAREL LEWIT, MD, DSC.

KAREL LEWIT, MD, DSC. Dynamic Neuromuscular Stabilization

Karel Lewit was born on April 25, 1916 in Ljubljana, Slovenia, Austro-Hungary and died on October 2, 2014 in Prague, Czech Republic. 1)

Karel Lewit was a neurologist and world authority in myoskeletal medicine. He was a pioneer of modern diagnostics and reflex therapy of musculoskeletal disorders in Czechoslovakia, and the world. As a young pediatric neurologist in 1948, he observed a demonstration of a non-medical manual treatment and started to study the manual therapy (mobilization and traction treatments). So far, these manipulation techniques were used only by “healers” (chiropractors and osteopaths).  Lewit started using them in 1951. In 1954, he and Karel Obrda, MD, founded the Rehabilitation Society, now the Myoskeletal Society. In the 1960s, he and his colleagues Vladimír Janda, Václav Vojta, Jan Jirout and František Véle, and others working at the prestigious Neurology Clinic directed by Dr. Kamil Henner in Prague, formed a group later known as the Prague School of Rehabilitation.

Lewit believed that pain is often caused by the antagonism of one tight muscle and another weak one, not by a structural disorder. 6) In 1979, Lewit also introduced the dry needling method In the treatment of trigger points for patients with myofascial pain syndrome. Lewit had noticed that the success of injections into trigger points in relieving pain was apparently unconnected to the analgesic used. 3) Lewit insisted on and practiced a holistic approach to his patients:

“I do not start with treatment until I have examined my patient completely. The critical link to his problems may be from past trauma, repetitive strain, or dysfunction of a key area.”  1)

“No instrument can replace our hands.” 7)

Lewit graduated from the Medical School in Prague in July 1946 with a degree in neurology. 2) After graduation, he joined the Neurology Clinic of the prominent neurologist Kamil Henner in Prague and worked there for next 13 years. It was here that Lewit became interested in problems of the spinal column and herniated disc disorders, and in the neuroradiology examination techniques of his colleague Jan Jirout, MD.

Besides treating his patients and teaching them the technique of self-care, Lewit lectured and conducted workshops worldwide, sometimes under absurd conditions during the Communist regime. He taught his diagnostic methods and the techniques of treating disorders of the locomotor system in five languages. He has trained hundreds of physicians, physical therapists and chiropractors in many countries (Germany, Poland, Austria, Bulgaria, the former Soviet Union, England, USA, Australia and New Zeeland). 5) During his long career, Lewit collaborated with world-renown experts such as J. Sachse, M. Berger, G. Gutmann, F. Gaymans, F. Mitchell, F. Greenman and D.G. Simons. 8)

Lewit’s doctoral thesis Manipulační léčba v rámci reflexní terapie [Manipulation in the Framework of Reflex Therapy], published in 1967, became the first Czech textbook of manual medicine. It was translated into German (7 editions), Dutch, Polish, Italian, Spanish, Russian, Swedish and Japanese, and rewritten and altered for the 3rd English edition,1999. Lewit’s methods were described in about 200 medical journals, books and videotapes (available both in Czech and English). 5)

On April 23, 2016, The Center for Complex Care (CPK) in Dobřichovice, Czech Republic, 3) a small town where Karel Lewit lived since his childhood, organized a conference to commemorate the 100th anniversary of Lewit’s birth. Lewit’s three daughters, who spearheaded the conference, announced the creation of The Karel Lewit Foundation to keep and promote the legacy of their father’s work and provide a platform for furthering the field of physical therapy and manual medicine. 4)

References:
1. Životopis prof. Karla Lewita [online]. Centrum komplexní péče Dobřichovice,   www.ckpsamova.cz/2014/10/zemrel-neurolog-a-specialista-na-myoskeletalni-medicinu-prof-lewit/
2. PROCHÁZKA, Miroslav, MUDr.Sbohem pane profesore (vzpomínka na neurologa Karla Lewita). Roš chodeš, Věstník židovských náboženských obcí v českých zemích a na Slovensku. 11 2014, roč. 76, čís. 5775, s. 13. ISSN 68 121074 68. https://cs.wikipedia.org/wiki/Ro%C5%A1_chode%C5%A1
3. Dry Needling. www.ncbi.nlm.nih.gov/pmc/articles/PMC4458928/
4. Konference ke 100. nedožitým narozeninám prof. Lewita (Conference to commemorate Lewit’s 100th year birthday) in Dobřichovice: Centrum komplexní péče.  www.karellewit.cz/cs/nadacni-fond/ (Czech)
5.BÍLKOVÁ, Iva;  Karel Lewit. FYZIOklinika fyzioterapie s.r.o. www.fyzioklinika.cz/clanky-o-zdravi/prof-mudr-karel-lewit-drsc/95-prof-mudr-karel-lewit-drsc
6. Czech Radio Vltava; Osudy Karel Lewit, 10 parts (in Czech) http://hledani.rozhlas.cz/iRadio/?query=karel+lewit&reader=&stanice%5B%5D=%C4%8CRo+Vltava&porad%5B%5D=  (Czech)
7.Na plovárně. Karel Lewit: Rozhovory Marka Ebena s významnými osobnostmi. www.ceskatelevize.cz/ivysilani/1093836883-na-plovarne/209522160100024-na-plovarne-s-karlem-lewitem
8. www.dns-cz.com/prazska-skola

Quotes

“We work with at the acceptable level of uncertainty.
The patient must always leave your office with homework.
What I know I have stolen n from Janda. He is an original. He does not steal.
Patient’s history is critical!

Feet are critical. People do not stand on their pelvis.
The role of a doctor as a teacher: The first treatment is to teach the patient to avoid what harms him.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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