Professor Karel Lewit, MD, DrSc: an appreciation

Professor Karel Lewit was born in 1916. He was forced to interrupt his studies at the Prague medical school because of World War II. He spent this time in the Czechoslovakian Army in England and later in France where he functioned as a member of the Czechoslovakian Armoured Brigade. In France, he met his beloved wife Iris, the charming young Englishwoman with whom he later spent over 60 years. Karel Lewit completed medical school in 1946 and began working at the Neurology Department under the legendary Professor Kamil Henner in the same year. Here, Professor Lewit found a unique setting for his work, which determined the rest of his career. Professor Henner brought the French style of clinical neurological assessment to Prague, mentoring young doctors but at the same time supporting them in their own studies and in the development of their own area of interest. It was no coincidence that not only Professor Lewit, but also two more ‘gurus’ of international rehabilitation, Professors Vojta and Janda came from the same clinic. Learning manipulation techniques, Karel realized that his treatment would have no permanent effect unless rehabilitation followed and the patient is educated in self-treatment. Closely working with neuroradiologist Professor Jirout, studying neuroradiology and functional pathology of the movement system, Karel soon understood that manipulation does not change the shape or the position of the structure but that via manipulative treatment he could change function in the musculoskeletal system. This led him to develop the whole self-treatment system for patients with pain in the musculoskeletal system that, with many modifications, is used worldwide now. Karel was the first clinician (probably not only in Czechoslovakia) introducing self-treatment techniques systematically. He also emphasized that the patient must leave the office with homework. His classic quotes are: ‘The one who knows a technique must not become the slave of it’, ‘For me, manipulation is a marginal type of treatment. The patient’s own muscles always do a better job than those of the best therapists. Therefore, we have to tailor the self-treatment for the specific patient and suggest an adequate selftreatment. If treatment is not helping it becomes frustrating: individual approach is critical’ (Figs. 1 and 2). Karel worked under Professor Henner for about 15 years, and after 1960 successfully continued his work at the various Neurology and Rehabilitation Departments in Czechoslovakia and later the Czech Republic. Progressively more lecturing and being involved in numerous research projects, Karel started to systematize his functional assessment and treatment techniques introducing a series of manipulative–rehabilitation–physiological courses together with Vladimir Janda and Frantisek Vele. In 1966, Karel published his first book called ‘Manipulative Treatment within a Context of Reflex Therapy’. The book that has been later rewritten many times, published in five Czech editions, three English, eight German, two Polish, Spanish, Russian, Italian, Japanese, and Swedish. Each edition, however, was almost a new book. Karel was never lazy about exploring new techniques and he modified what he did, taught and published in the light of new facts and discoveries. He never wanted to be petrified. ‘I can only teach with today’s acceptable level of errors. I have to respect development and play an active role. Who would listen to me today if I taught the same thing as 40 years ago?’ Karel Lewit had been a passionate advocate of the functional aspect of musculoskeletal pain. ‘Henner taught us that the clinical picture was always the most important. The other examination techniques, such as imaging methods, blood analysis, or any other was complementary. It scares me that today I Correspondence to: Alena Kobesova, MD. PhD., Department of Rehabilitation and Sports Medicine, Second Medical Faculty, Charles University and University Hospital Motol, V Uvalu 84, Prague 5, 159 00, Czech Republic. Email: alenamudr@me.com