Dr Karel Lewit brought the regional interdependence model to life with every single patient.
“He who treats the site of pain is lost”
Lets look at the neck.
- We commonly see high levels of tension (e.g. hypertonus) in the upper trapezius & suboccipitals.
- Is this a primary problem?
Certainly prolonged sitting can makes these muscles work as a check-rein against
gravity and overload them. This can result in them building up tension which they develop amnesia of how to let go of. So it would be plausible for neck tension & stiffness in this area to be a primary dysfunction.
But, is it true & can we prove it?
Dr Lewit used the Clinical Audit Process (CAP) to ascertain if something was primary or not.
He formed a hypothesis about the relationship between different links in the kinetic chain.
He tested his hypothesis with an intervention to the supposed “key link”
Naturally, he re-assessed.
“Immediate testing i.e. comparison of the state before and after treatment, thus constitutes a feedback which enables us to assess not only treatment but diagnosis on the spot, an aspect that is indispensible for the critical therapist.” p138, 139
K Lewit Manipulative Therapy in Rehabilitation of the Locomotor System (3rd ed)
Links on the CAP:
In the case of the cervical spine if he noted tension in standing he had a simple screen to see if the problem might hypothetically be secondary to a distant dysfunction.
He would have the person sit and re-evaluate the soft tissue or muscular hypertonus.
If the tension was significantly lessened in sitting he hypothesized that the dependent variable (variable he changed) was the lower quarter kinetic chain, NOT the neck.
Therefore, the “key link” or dysfunctional driver was in the lower quarter and the neck problem was secondary.
To prove this hypothesis he would evaluate the lower quarter, identify a key 
dysfunction. Perform an intervention and then re-evaluate neck tension in standing.
Another common CAUSE of neck tension is of course faulty respiration. According to Lewit, “the most important respirational fault is lifting the thorax with the auxiliary cervical muscles instead of widening it in the horizontal plane….it overstrains the cervical musculature and cervical spine causing recurrent cervical syndromes.” p28
K Lewit Manipulative Therapy in Rehabilitation of the Locomotor System (3rd ed)
(coming soon)
From hypothesis comes testing. The logic is faulty without scientific testing; a hypothesis is not proved in the above manner. For example, how many patient’s cervical spine did not change? or increased tension after the intervention? or how many patients cervical spine did not change after gravitational or functional changes?
I agree 100%. It is not a proof. An empirical observation & case study analysis. N = 1. Outcome based practices – which is what I have work at as Dr Lewit said “the level of acceptable uncertainty”. An RCT would be much more powerful evidence which this is not.
Thanks for your comment.
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Posture is often a huge mitigation factor in neck pain. If you rest your head too far forward, the C-shape of your spine will be compromised and increase the amount of stress placed on ligaments, muscles, joints and disks in your neck.
The spine is a single synchronously moving gavity fighting dynamic tower – to divide it up into cervical, thoracic and lumbar spine seems rather primitive. When considered as a whole it becomes appearent that it will also compensate as a whole. Advanced Biostructural Correction is the only theory/practise that explains total body mechanics and how to correct it. Forward head carriage and associated lumbar myofacsial hypertonicity and/or hyperlordosis due to thoracic vertabraes going forward and associated meningeal adhesions to hold them in place, since there is no muscle able to pull straight back – would constitute a normal full spine compensation pattern causing lumbar spine overloading-pain but obviously not the site of the real cause. Check out ABC and leap forward into the future of how spines really work,
compensate and fail, Greetings, Mats Hansson