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:
- Anatomy and physiology – mostly
neurological aspects of the spine and musculoskeletal system
- Orthopedic neurological clinical and
instrumental exam methods
- Etiology of the majority of vertebral
- Pathogenesis and Sanogenesis (the
process of natural compensation, regeneration, repair,
- Clinical syndromes
- Nosologic forms (diseases)
- Differential diagnosis
- Treatment codes. (Rules, Variations, Methods)
Treatment and Self-Treatment
- Prophylaxis (Prevention)
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
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
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
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
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
c. To bring out the essence of fixation due to its organic causes
(i.e. calcification) or functional causes (i.e. muscular
d. To observe stability of the fixation complex – its compensative
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
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.
President of Orthopedic Neurology Research Fund - Dr. Alex Popelansky, Ph.D.