Dear colleagues.

I would be applauding your professional curiosity to consult the “iron-curtained” Eastern European approach. I would be, also, finding this curiosity to be very progressive and encouraging. For instance, sparing time from deep elaborations about neuro-physiology, neuro-histology, as well as rewarding curing therapies, high-ranking American conterminous medicine forgot about the integrating approach to pathogenesis and immensity of multiple distinguished clinical syndromes of the most widely spread chronic condition, the back pain. Meanwhile, precise knowledge of concrete syndrome’s mechanism opens the opportunity for optimal therapeutic purposefulness by different methods. Giving full credit to this postulate, my teachers had been working up the problem of vertebrogenic nervous system diseases from the middle of the last century. I have begun to take over their new accomplishments even back in medical school. That is why your aim to improve education and management of back pain has made me excited as it has also reminded me the youth of my professional life.
I am a neurologist and a manual therapist. During last 27 years, before coming to the U.S. in 1999, I had been working as a physician, scientist and then a professor in the field of spinal neurology. Around 25 years ago, my colleagues and I were creating a similar project. We have established an absolutely new discipline in “Continued Education for Physician Schooling”. We have developed the original 480-hour course based on my father’s Federal Vertebroneurological Center Doctrine about intervertebral osteohondrosis. My father – Jacob Popelansky, is the founder of Vertebro-Neurology (Spinal Neurology, Orthopedic Neurology), a discipline that is on the junction of Neurology, Orthopedics, Internal and Manual Medicine, Otolaryngology, Urology, and Gynecology (for more information please visit the English version of our site www.spinalneurology.com).

This 480-hour course included:

 
I have been the first Manual Therapy instructor in the former USSR. Myself and my colleagues have combined this European study with Vertebro-Neurology due to their natural interdependence and mutual enrichment of each other.

Our objectives and the approach in therapy of spinal disease are very different and much more progressive in comparison to the traditional ones:

1) It depends on the essence and the course of the main vertebral (clinical complex around the spine) and subordinate (secondary) – extra-vertebral (in the head, extremities, pelvis, stomach, chest etc.) syndromes.
2) To distinguish the determinant of the whole disease from the conductive (contributory, evolutive) factors, and from the exacerbating (provocative) factors.
3) To discern and attenuate compressive, disficsative, disgemic (stasis, venous stagnation, microcirculation disturbances), aseptic inflammatory, and autoimmune affecting mechanisms (determinant factors) of spinal locomotor segment’s structure.
4) To diagnose and deduce whether there is compressional, reflex or adaptive pathological involvement of spinal and peripheral roots, nerves, vessels, muscles, tendons, ligaments, capsules, joints and etc.
5) To define and eliminate or weaken vertebrogenic muscular and perearticular dystrophic phenomena, muscular and vascular dystonic reactions, and autonomic nervous system disturbances.
6) To analyze several fragments of the static reactions (scoliosis, hyperlordosis, constrained postures etc.) and dynamic fixative reactions of the musculoskeletal system (range of motion limitation, stiffness, frozen joints etc.) - the characteristics of present locomotive stereotype.
a. To estimate the intensity level of static and dynamic manifestations of patient’s fixation.
b. To define the spread and diffusion of the clinical picture of the fixative system.
c. To bring out the essence of fixation due to its organic causes (i.e. calcification) or functional causes (i.e. muscular –“miofixation”).
d. To observe stability of the fixation complex – its compensative reliability.
e. To examine some other aspects of above-mentioned fixative responses in pursuit of the main result – to determine the direction and perfection of the new motor stereotype. Is it compensative, sub compensative, neutral (indifferent), or harmful? How does it affect the course of the disease?
f. To discern whether it is a useful (sanogenic) protective fixation or it is a destructive (pathogenic) disfixation?

In the case of the present motor stereotype’s positivism in protection from the main cause of the disease, we contribute to the intensification of the existing neuro-motor complex by all possible treatments. When responsive course of locomotor patterns is not adequate (i.e. it is harmful and deteriorates the course of the disease), we try to destroy the negative process and stop it by all available methods. We then form an adequate locomotor stereotype. If the formation of any static and dynamic syndromes is accompanied by new complications (like entrapment or trigger point syndromes, etc.), we try to eliminate them electively from the beginning by different accessible hereafter described ways.

Taking into account different details of fixation along with algesic (painful) and algogenic symptoms (consideration of painful-fixative patterns of their associations and dissociations), provides an important possibility of earlier differentiation between a tumor, inflammation, hidden rupture, hormonal and traumatic spondylopathy, viscerogenic spondylalgia as well as the most widely spread chronic disease -- intervertebral osteochondrosis.

Such style of analyses allows to go into the matter of the problem and puzzle out where, what, when and how to use different resources and methods in a concrete clinical case. Owing to our comprehension, demarcation, and bringing out of many syndromes, we use lots of different adequate medications in oral and parenteral ways. We certainly put into practice manual and physical therapy, myofascial release, infiltrations (impregnation, local treatment by injection), blockades (including epidural), “dry” needle, fasciotomy, and compresses.

Thus, our immersed clinical and morphological analysis of syndromes for each patient allows for an individually focused adequate system of treatment that involves a variety of methods and methodics.

We appeal to neurosurgery only in the case of a real danger of spinal cord or cauda equine compression.
If our patient suffers from epiduritis (chronic deep scarring process) after numerous inflammatory exacerbations or past surgery, we do not fall back on radical actions. We conduct an appropriate purposeful conservative dissolving therapy by different sorts.

One of the goals of our organization is to provide a chance for appropriate specialists to acquire our knowledge and craftsmanship for its popularization in the United States.

Attached, are the inscriptions of the world-known Manuals, as well as the letters from the renowned authors that demonstrate their connection to our doctrine.

Sincerely,
President of Orthopedic Neurology Research Fund - Dr. Alex Popelansky, Ph.D.