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The Enduring Message of Vladimir Janda, MD, DSc

The Enduring Message of Vladimir Janda, MD, DSc

By Craig Morris, DC {Click title for original article}

Dynamic Chiropractic – April 21, 2003, Vol. 21, Issue 09

Much has been written about the recent passing of Professor Vladimir Janda. Praises from distinguished multidisciplinary groups have been heaped upon this gentleman, a disabled (polio-stricken) medical doctor from Prague. Just what was his message, and why was it so profound to arouse such accolades?

Understanding Professor Janda's background and training allows one to better appreciate his contribution. His disability, which began during his teenage years, enhanced his observational skills to almost unbelievable proportions. Because he was initially trained as a neurologist who later specialized in manual medicine and rehabilitation, he was uniquely qualified to explain the complex nature of chronic pain syndromes in a manner that integrated neurologically based principles with manual techniques. At the rehabilitation clinic he founded at Charles University in Prague, he supervised cases on a daily basis that varied from myofascial pain, to posttraumatic quadriplegia, to cerebral palsy, and did so for decades. His understanding of kinesiology and EMG testing/research was elevated to the highest level when he completed a fellowship with the legendary Professor John V. Basmajian of Canada in the 1960s. Appointed as a representative for the World Health Organization in the 1970s, he traveled the world to establish rehabilitation hospitals in third-world countries.

Armed with such a unique and vast clinical armamentarium, Janda started to integrate his knowledge with observed consistent patterns in various chronic pain syndromes. These patterns of muscular imbalances led to stereotypically altered postures; altered gaits; trigger point patterns; joint dysfunctions; and pain syndromes. He found this movement was neurologically mediated and required a comprehensive understanding of manual techniques, such as manipulation and muscle-balancing measures, and neurophysiologically based techniques to attain long-term improvement. Inspired by the proprioceptive facilitatory techniques of Herman Kabat, MD and Sister Elizabeth Kenney, he integrated these methods into his rehabilitative model. A proponent of manipulation, myofascial procedures and exercise, he found that each approach alone was insufficient for the chronic syndrome. As he wrote about his findings, a growing list of global admirers invited him to come and share his unique insights. Professor Karel Lewit, Janda's colleague, once commented on his own understanding of "sensorimotor system" dysfunction by saying: "I learn from everyone, especially Janda. His insights are original."

Professor Janda is perhaps best known for his identification of three postural syndromes: the upper (proximal) crossed; lower (distal or pelvic) crossed; and layer syndromes. Briefly, each of these clinical scenarios described conditions in which the tone of antagonistic muscle groups became imbalanced and led to the predictable sequelae of pain and dysfunction.

When asked about his contribution to the worlds of physical therapy, chiropractic, osteopathy and manual medicine, Professor Janda stated that he directed each group toward the importance of muscle dysfunction in the perpetuation of musculoskeletal pain syndromes. At one time, he felt each group focused too heavily on dysfunction of the passive joints.

Attempting to briefly encapsulate Janda's message is practically impossible because of the breadth and complexity of the topic. In the simplest terms, it all boils down to the nervous system. The coordination of afferentation, central organization of neural data, and efferentation was paramount to the quality of function. To him, joint function was dependent on muscle function, which was dependent on nervous system function, although each of these factors was at times interdependent. A reader of these words who studied with Janda could easily find fault, because he emphasized so many other aspects that could lead to dysfunction and subsequent pain. Such factors included psychosocial; nutritional; ergonomic; congenital; endocrine; genetic; traumatic (micro- and macro-); occupational; and sports.

To appreciate Janda's brilliance, one truly needed to see him in action - teaching one of his courses, especially when he was assessing a patient. Students were amazed as he told the patient about his or her past history of injury, simply by glancing at posture or watching the patient take a few steps. Whether assessing chronic back pain or severe brain trauma, his students were left spellbound by the clarity of his observations; his insights into each condition; the complexity of the etiology and confounding factors he detailed; and his comprehensive treatment options.

Professor Janda was not without doubters. Some complained his observations seemed too subjective, and were unable to be consistently recreated or measured; some of these complaints may be true. Many of his visual observations required a keen eye and fall under the heading of "art," as do palpatory findings. However, many of his original observations may not be fully accepted in the international scientific community, because the technology does not yet exist to prove or disprove them. However, one example of Janda's genius may help to clarify this topic to the reader.

Janda first addressed his concepts to Australian physiotherapists in the 1970s. Among his many findings was that patients with chronic low back conditions frequently had inactive abdominal muscles, especially the transversus. He noted that the abdomen was rounded in such cases. This, along with his emphasis on muscle dysfunction, rather than just joint dysfunction, led the Australian PTs to later utilize fine-wire EMG studies and diagnostic ultrasound, to prove the existence of what is now called the "pressurized canister." This reasoning revolutionized our understanding of lumbopelvic stability, but it required the genius of Janda to observe and explain it so others could later prove it.

Professor Vladimir Janda was an original genius. His insights were revolutionary, and his message inspired a multiprofessional global audience for decades. Those who were his students will be able to state proudly for the rest of their lives, "I studied with Janda." It remains the duty of his protégés to continue to share his message; to better understand its complexity; to strive to prove his tenets as technology allows; and to build upon the groundwork laid by this humble master.

For me, my relationship with Professor Vladimir Janda evolved over the years, from instructor to mentor, from friend to family member. Thank you, Vlad. Sleep well.

Craig E. Morris, DC, DACRB, FAFICC, CSCS
Torrance, California

Dr. Craig Morris is a 1981 graduate of, and retired clinical professor from, Cleveland Chiropractic College, Los Angeles. He is board certified in chiropractic rehabilitation and the editor of Low Back Syndromes, Integrated Clinical Management (McGraw Hill), a multidisciplinary textbook. He has taught sports / rehabilitation on all five continents.