NAAMM ORGANIZATIONAL MEETING

The organizational meeting of what became The North American Academy of Manipulative Medicine (later Manual Medicine) was called for 11:00 P.M., December 1966 at the Waldorf Astoria, in New York during one of the coldest winter spells of that decade. We came from all over the U.S. and Canada. Left to right: McMennell, Goodley, Travell, Kanaar, Godrey, Jacob Rudd, the 1st President, a good and dedicated man.

TRAVELL & ME

In 1968, I was invited to present a paper at The Fifth Int'l Congress of Physical Medicine in Montreal, Canada, titled "Joint Manipulation & It's Applicability to Industrial Practice." I was still in General Practice. NAAMM was just starting. Dr. Travell and I were obviously on very good terms.

DR. JOHN McMENNELL

Mennell introduced me to manipulative techniques early in my general practice, in 1961, with a 20 hr. very basic course, the influence of which I describe in Release From Pain. He was responsible for my becoming one of the founders of NAAMM. I thought he was my friend.

DR. KENNETH BOAKE

Ken will always be one of the pleasures of my life. Soft spoken, gentle, another NAAMM founding member, he was one of the first presidents. A Canadian, he remained steady.

DR. CHARLES GODFREY

Charles was also one of the founding members of NAAMM. Also Canadian, he was a member of the government and was always a quiet, stabilizing presence.

THE FRENCH GROUP

NAMM began after a meeting in which Dr. Robert Maigne from Paris, France became influential among the Americans. I met him during the NAAMM meetings, and he invited me to study with him for six weeks in 1972. Subsequently, I decided to begin in a residency in PM&R at The University of Southern California (USC). It would commence shortly after I would leave for my scheduled trip. Dr. Betty Austin, the chief, allowed me to go as part of my first year. It was about this trip – that serendipitously extended to include learning with Cyriax and Kaltenborn - that I wrote the NAAMM Newsletter, “Goodley’s Travels – A Voyage Among the Giants” with the Board’s blessings. It was so influential that it became the instrument for my leaving NAAMM and being fired from my residency (The Newsletter is in “Archives.”): Betty suddenly retired and was replaced by Dr. Rene Cailliet. At the end of my first year, in collaboration with members of the NAAMM Board, he fired me and thereafter expended himself trying to assure I would never finish my specialty training. It was an “interesting” beginning of my specialist career.

This photo is of the faculty and attending staff at Hotel Dieux, the oldest hospital in France, across from Notre Dam Cathedral, where the course was conducted. Robert is seated on the far right. Kneeling in the front row in a clinic coat is Dr. Francois LeCourre, Robert’s close associate.

FREDDY KALTENBORN (right) and OLAF EVJENTH

Freddy and Olaf are Norwegian physical therapists. I have never experienced more precise manipulations than by Freddy’s large hands. Olaf was a Norwegian Olympic coach, a great man and both consummate teachers. It was Freddy who taught me the joint mobilization techniques that I discuss in Release From Pain, that have been so successful in my practice. I didn’t know that Maigne was heavily antagonistic towards Kaltenborn. My writing as I did, in which I spoke candidly, as I was advised to do (so long as I expressed only my own opinion), was seen as a political blow to Robert’s emotional supporters – and all hell broke loose. Later in 1972, I was the only American physician at the month-long manual therapy course the Freddy and Olaf conducted in the Canary Islands.

About 10 years later, Freddy was in Los Angeles. I visited him in his hotel room. His attaché case was open. I was stunned to see a heavily highlighted copy of Goodley’s Travels on top of the papers he had with him.

MAIGNE IN HAWAII

Dr. Robert Maigne teaching at the NAAMM 1971 meeting in Hawaii. I was 1^st Vice President, had continued as Newsletter Editor and would become President at the 1972 meeting in Miami, Florida. I didn’t and didn’t return to a NAAMM meeting for eight years – for only two years.

DR. JAMES CYRIAX AT ST. ANDREWS

As I traveled to Paris to study with Maigne, I stopped in London for the first time for a few days and met Dr. James Cyriax for the first time. (I will discuss him at length under “People.”) I learned that once a year, Jimmy held court for “physicians” who came from around the world to observe him for a week. It was scheduled for about three weeks later when, it turned out, that for most of that particular week Paris would be on holiday. Despite secretarial protestations that it was “impossible” for me to attend, that the course was set two years ahead, I had no intention of missing it. Very happily, there was a sudden cancellation, and I was accepted. This photo is of the group, of course with a tripod/timer. Dr. Cyriax is (obviously) in the center in a brown suit. I am at his left shoulder (right side looking at the photo.) (A number of the “physicians” were actually physical therapists, including Dick Erhard – standing 2nd From the left – who later became also a D.C. and Sandy Burkhart – standing 5th from the left in white shirt. They were the ones who told me that Freddy Kaltenborn, who I was unaware of, would be teaching in New London, Ontario, Canada, just before the close of the Maigne session, so I was able to leave a few days early and attend all three methods of teaching in 45 days. Please read the Newsletter – Goodley’s Travels – A Voyage Among The Giants.

DR RONNIE BARBOUR AND DAVID LAMB

Ronnie was Jimmy’s associate in his London office. He performed the first prolotherapy injections I ever saw. He was short, about 5’ 9” and told me he had been over 6 feet tall before he developed scoliosis. He said that so long as he had prolo yearly he had no pain. He volunteered that he gave about 20 prolo injections to the low back in, as I recall, 30 seconds. I didn’t believe him then (and I still don’t), but when he started to inject a patient, and I looked at my watch, he smiled and moved with almost lightning speed. But I had no proof he injected where he said he did, and there is never reason to rush.

David Lamb was a physical therapist in the British Army (along with Cliff Fowler). They were closely associated with Freddy. Dave, unfortunately, passed away some years ago as, still, a young man.

FREDDY KALTENBORN & CLASS IN CANADA

Freddy is in the 2nd full row just behind the young woman in the blue dress looking up to her right. Olaf isn’t in this picture. Sandy Burkhart is back row furthest left. Cliff Fowler just to the right of middle, lower than the two tall heads on either side. John Oldham is just in front and to Cliff’s right. Dick Erhard has a beard, back row right. I’m in the front on the left

DR. JAMES CYRIAX IN SAN FRANCISCO

After meeting and then corresponding with Jimmy for a few years, I wanted a photo of him for my wall. He repeatedly had none. He once sent me a very distant, very amateur blurred snapshot of him rushing across a street somewhere. Perhaps 1971, as I entered the lobby of the St. Francis Hotel, in San Francisco, it was close to 2 A.M. Jimmy was standing by the wall in the illumination of a 25 watt bulb. I took out the Mini Rollei 35 mm. camera I had with me and told him not to move. He smiled as asked, “What are you doing, dear boy?” I repeated my statement. This was the result of a hand held half second exposure. I made two, sent them to him in England and told him to sign one and send it back. It graced my wall for years. Jimmy was a compound character. I’ll discuss him more

Dr. CARRIE CHAPMAN

Carrie was President of NAAMM in 1972. She was a quiet, unimposing lady. We coincidentally flew to the Miami meeting together, me effervescent, her subdued and sheepish. I didn’t have a clue about what had transpired.

DR. JOHN BOURDILLON

When I arrived at the hotel for the 1972 NAAMM meeting, John soberly invited me to the bar to have a drink with him. There, he apologized for replacing me as the next President. I didn’t have the slightest idea what he was talking about. The Board had met clandestinely and removed me from the slate. It was a bad, bad meeting. When I arrived back at USC, I told that to Dr. Rene Cailliet, then my chief. He turned purple and said he knew. He looked at me and asked, “Do you know what you are?” I shrugged. He said, “You’re a maverick!” I reflected and quietly asked him, “What’s wrong with being a maverick?” He turned purple –purple. He almost screamed, “Nothing! Nothing!” A few months later, he precipitously terminated my residency.

DR’S TED LIBERSON AND JOHN BOURDILLON

DR. JANET TRAVELL

Travell’s fame was that she was one of President John Kennedy’s physicians. I bought one of her books when it was published: Office Hours, Day and Night (As I recall.). When she signed it, she wrote effusively on the inside cover that I was the only person she’d ever met who reminded her of the energy of her father. As is well known, she was (is) a strong advocate of trigger points and wrote the book with Dave Simon.

My Goodley’s Travels Newsletter had earned me congratulatory messages from around the world, but/and it infuriated at least the majority of the NAAMM Board. That was a realistic measure of its individual intentions. She even declared in my presence that my publishing the list of physical therapists who had taken the Canadian course with Kaltenborn was an unethical act which should jeopardize me in medicine. In the end, I finished my residency training “in exile” at the University of California at Davis, and, in the end, it was well, but the events that started in 1972 eventually led to the demise of NAAMM and set back, with other events, orthopaedic medicine for decades.

PETER EDGELOW

Peter is also Canadian. We met in the 1973 when he helped conduct a course for physical therapists at Stanford University. Goeffrey Maitland came from Australia, Freddy from Norway, and I was honored to participate, as well. Peter and I became friends, and it grows over the years as he has advanced in his career and his profession, devised new therapies, and never lost his gentleness and sense of place in the scheme of things. He wrote the Physical Therapy Foreword to Release From Pain.

From the Scrolling Bar

Dr. James (Jimmy) Cyriax. Deservedly controversial, is unquestionably the instigator of Orthopaedic Medicine.

Dr Alva Gregory, a medical prophet, warned in the early 1900's of the confusion if traditional medicine rejected clinical biomechanics - manipulative techniques.

It is wise to consider the skin another aspect of the nervous system. Picking it up, rolling it, should be pain free and reveal little change in texture or color.

Severe segmental Cutaneous Hyperalgesia. When an area of skin approximating the width of a dermatome is lifted and rolled it is found to be extremely tender, thick, waxy and turns violently red. It is essential to diagnose this condition. Its treatment is the same - rolling the skin.

Arguably, the most divisive confusion in orthopedics is that M.D.s are not trained in the basic segmental examination of the spine.

Intra-articular synovial tags - that can become entrapped (indefinitely) from a disadvantageous segmental movement, and may be released only by manipulation. (Written permission granted to show this dissection by Wolfgang Rauschning, M.D. by William V. Glenn, M.D.)

The curvature of the spine is largely an illusion that encourages one to think of a reed bending. Movement is only possible at specific sites. The ability to assess them is essential in this work.

This nurse at UC Davis had had an L5-S1 herniated disc repair years before. Then, after a DC, she developed back pain and could no longer flex her spine. She remained that way for over a year under the assumption that it was related to her surgery. Her dysfunction, however, was at L3. Her pain was relieved immediately after it was released with a manipulation, and she promptly flexed to touch her toes. There was no recurrence.

For many reasons, "Repetitive Bilateral Lateral Bending" (RBLB) - continuing to move metronome-like side to side in the mid plane - is a valuable part of the initial exam.

In my experience, the subtlest sign of lower lumbar radiculopathy is impaired synchrony of the ankle dorsi and plantar flexors that causes a floppiness of the ankle joint, observed by shaking the relaxed joint at right angles to its axis of rotation. I call the test "Ankle Oscillation Response." (For the test to be reliable there must be no ligament laxity from previous injury.)

Thermography objectifies dysfunction and early radiculopathy earlier than any other technology. It is unique. Its popularization was destroyed from within and without by fear and greed. The story must be known.

During 1970-72, this man regularly attended the clinics of USC/LAC Medical Center and showed this sketch he drew while unsuccessfully asking for his pain to be relieved. He was cured with one mobilization and an intra-articular cortisone injection. Despite the ease of diagnosis, the AC (acromioclavicular) joint (is, was) the hidden largely unattended joint of the shoulder.

Maria's right shoulder joint had been destroyed by (Juvenile) Rheumatoid Arthritis. For almost two years, virtually any abduction caused agonizing pain. She was being considered for a hemi-acromiotomy.

Three days of short fulcrum mobilization and a few minutes of self-administered axial traction twice a day using a belt fully restored painless functional motion apparently by distracting the joint and releasing soft tissue entrapment. Scapulo-humeral abduction was still less than 10 degrees, but for the first time since her illness began she was able to add her scapular rotation thus gaining an additional 60 degrees of range and put on her pony tail hair clip by herself.

"Swaying range" - a test I have found useful in the diagnosis of cryptic shoulder pain when the source is teres major strain at the scapula. Swaying the relaxed arms causes the involved scapula to "jump."

(Left to right) Olaf Evjenth and Freddy Kaltenborn, (1972)

Axial traction on the hip - an essential treatment to relieve a unique diagnosis. (My cinearthrography demonstrating soft tissue entrapment in the hip relieved with manipulation will be shown on this website.)

Short fulcrum mobilization is likely more effective in restoring impaired joint motion, and it is pain free.

Thermography is the most important objectifier of the subtleties of the orthopaedic dysfunctional process. I introduced this thermogram into the California Workers' Compensation System to successfully settle the first case in which this technology was used (1980).

This thermogram, one of the full study, settled the first case in which thermography was introduced into the Superior Court in California (Kavalovsky v AP Liquor Store, Sacramento Superior Court, 247410, March 1977).

Lawrence (Larry) Jones, D.O., one of the heroes of medicine, discoverer of Counter Strain Techniques. After curing a patient by serendipity, he spent the rest of his life studying and expanding the method.

The rationale for traction has largely been lost. This patient was cured from years of post-traumatic neck pain repeatedly exacerbated by car travel by a few days of continuous appropriate cervical traction with two pounds force.

Sayre type traction was never intended for cervical traction. It is non-specific, pulls only the head and tends to deliver hazardous force to the TMJs.

Rapidly rotating the forearms around each other, both directions, is an excellent screening test for parietal lobe (motor strip) abnormality. The side opposite the brain lesion fails as the other forearm unilaterally orbits.

A new diagnosis: Soft tissue entrapment in the AC joint - a unique case. Pat suffered agonizing pain for 15 months from virtually any movement of her right shoulder. Eventually she was recirculated to the PMR Clinic, U.C. Davis/ Sacramento Medical Center with the prescription: "Teach this woman to move her right arm."

Arthrograms of Pat's right AC. Note the virtual absence of dye in the interspace.

Arthrograms of the supposedly normal left AC.

Anita's case is the epitome of orthopaedic medical aspiration in which "it all comes together. For six years, she was totally disabled, unable to move her left shoulder at all without experiencing agonizing pain.

Vaginal (and sometimes rectal) examination may be essential for accurate diagnosis of disabling low back pain. Two women were cured of long duration low back pain associated with dyspareunia after vaginal diagnosis and transvaginal injection therapy. (Both had had multiple allegedly normal pelvic exams.)

Normal scapular mobilization with half the examiner's hand sliding under the scapula.

Dysfunction of the Symphysis pubis can be the sole cause of disabling low back pain. While it may be tender, all the symptoms refer to the back. The relief is manipulative.

Acupuncture can provide remarkable relief. But it cannot cancel the basic truths: First, accurate diagnosis, and, unless a dysfunction has first been relieved, any pain relief will almost surely be only temporary.