. : What is what the Syndrome of ?
: I am not responsible for this name! I drew the attention to the existence and the frequency of pains projected from the dorso-lumbar hinge which are responsible for misleading clinical pictures and I described semiology of it. I had grouped them under the name of “Syndrome of the dorso-lumbar hinge”. But it seems that they are more known under the name than you mention! I do not disavow it.
It is initially about a generally unilateral low low back pain. It resembles completely a low back pain of origin with which it is usually confused. It is most frequent and the first demonstration which I identified and described in 1972.
Then the board was supplemented with stomach pains or simulating intestinal, urologic pains perfectly and especially gynaecological extremely misleading because they lead to repeated browsings, finally more rarely of the pubic pains.
Significant item: the patient never complains about pain on the level of the dorso-lumbar hinge. And the aforementioned is usually radiologically normal. Semiology is purely clinical. On the other hand it is not rare only the area present of the important degenerative radiological lesions or the after-effects of intervention which draw the attention wrongly…. But the mixed forms of low back pains are not rare.

. : How did you can make converge towards the dorso-lumbar hinge such a beam of symptoms?
: Of formation, I had been brought to interest me in the common , qualified at the time of “” because nothing came to objectify this pain, frequent subject of consultation; and which was well seldom relieved by the processing or medical.
They were often young women, but they did not have exclusiveness in it. They complained about a tough pain accentuated by work, making the aforementioned very painful sometimes impossible.
The negativity of the usual examinations, picturesque description that made the victims of them: “a #53B0A6 iron in the back”, carried much our colleagues to regard this as psychogenic. Psychotherapy, relieving helped them sometimes, but the resumption of work brought back the pain.
I had been struck by examining these patients a little more closely to note that there was a painful point precise para found at all. The pressure on this point reproduced the usual pain, while the neighbouring skin, on a tape going towards the , “” particularly painful and was thickened with the maneuvre of grip-rolled.
I had noticed in addition that one of the most frequent incidents of cervical handling evil made was precisely such a back pains with the same signs of examination. I found the same thing in the case of the neuralgias , which begin besides often with an isolated back pains.
It became obvious that the had a low cervical origin. I regularly found with the examination a pain relating to the articular posterior one of - or - on the same side as the dorsal point and the . The radios were normal or showed banal lesions. The patients complained only exceptionally neck. And yet, the infiltration of this hinge involved almost at once the disappearance of the spontaneous pain, the point para and the . Even result with handling if it were possible. That repeated on tens and tens of case.
There thus existed reversible “lesions” of the micromechanical vertebral segment of nature. They could involve remote pains by determining neurotrophic disturbances in tissues, here the “” undoubtedly by the means of the posterior branches of the spinal nerves.
That led me to pay attention to the posterior branches and to note the interest of “grip-rolled” in semiology when it is about an area of limited and unilateral . The aforementioned often corresponds to the cutaneous distribution of the nerve, with regard to the trunk.

. : And you implemented the same reasoning to the low low back pains?
R. Mr.: Yes but it came gradually.
I had noted well that certain forwarded to the superior party of the buttock a area, and that the anesthetic infiltration of the aforementioned followed by massage in surface kneading brought an interesting relief to these patients who answered badly in addition the epidural infiltrations and rehabilitation.
The idea had come to me that it could be a question of an irritation of the posterior branches, but the Treaties of anatomy which mentioned them allotted to and the cutaneous of the higher buttock area, and my segmentary examination did not detect any specific pain on these segments.
On the other hand there existed on the iliac crest a painful point with 7 or 10 centimetres of the line of centers of which the infiltration relieved often well, momentarily, but well these patients. The American authors allotted this point to the ligament , pulled about by the 5th lumbar one. That appeared not very probable to me because the ilio-lumbar ligament fits on the internal bank of the wing and of this fact is not palpable, whereas the “point of peak” is very surface.
It took me a certain time to note that the infiltration of this point also made the area buttock flexible and painless.
I returned to the idea of posterior branches and I sought higher. I noted indeed that there existed with the examination a painful segment of the dorso-lumbar hinge. It was - generally but sometimes - more rarely - .
The infiltration of articular posterior painful with the examination made disappear in a few moments the pain from the patient and the signs from examination. It was particularly spectacular in the acute form of this low back pain which completely has the pace of the conventional acute lumbago with strong diminishes but generally without antalgic attitude. If it were possible handling the same negotiable instrument had.
Two series of dissections made with my collaborators showed us well that cutaneous veins of the posterior branches and ensure with the essence of the of the cutaneous plans higher glutei in the area where the is present, and which they cross with right angle the iliac crest with 7 or 10 centimetre of the line of centers, which explains the “point of peak”.
The “low low back pain of high origin” had become a routine of the service when I decided to publish in the Society of Physical therapy then at the Society of Rheumatology.

. : How were you accommodated?
: Very well with the Physical therapy. I was besides Secrétaire of Society and the majority of the members composing it knew my work. Certain provincial owners sent to me regularly with the Hospital their interns or their chiefs for more or less long durations.
I received also foreign residents come from a little everywhere: Italy, Spain, and, also Americans and especially Canadians. Until my departure of the Hospital we had during more than 15 years of the Canadian residents in a quasi constant way.
It is true that I had been able to create in Paris VI thanks to the seniors and teaching a one year in the form of a of “csotcina.comedic Medicine and therapeutic manual”. This teaching which contained exchange rates, practical works and consultations clinical made that the participants lived the life of the service and could initiate themselves perfectly with our specific approach of the diagnosis and the communes pain treatment of vertebral origin.
The greeting was less homogeneous with the Rheumatology.
Very favorable on behalf of the provincial owners who directly or by their interns or pupils had regular contacts with the service. With skepticism for a good majority and clear hostility for some.
One of the Masters of the Rheumatology of the time rose to tell: “If I understand my dear well you inject a posterior hinge and you relieve a low back pain. Learn that the day or a posterior articular infiltration will relieve a low back pain, did not come.”

. : Why?
: That did not have anything personnel. This same owner had without I asking it to him written an extremely flattering foreword for my first book whose bond was “vertebral Handling”, which was a particularly delicate topic in the Sixties. But at the time all was of the intervertebral discs! It was necessary to wait a little so that the posterior hinges forgotten since find a topicality, but they was those of the rachis!

. : But which is pathology responsible on the level for the dorso-lumbar hinge?
: With what does correspond the segment of the dorso-lumbar hinge found painful to the examination? It is the question!
I would remind the meeting that the imagery does not show anything in particular. It is very exceptionally that it reveals a slipped disc with lumbar or abdominal purely painful expression.
This painful segment forwards what I called a “minor intervertebral disturbance”. That can be observed on all the levels of the rachis. These “minor intervertebral disturbances” or are usually the consequence of efforts, clumsy movements, poor postures… They are the cause of the majority of the banal pains.
The can be momentary, to even disappear from him, but it can persist of the months, of the years, person responsible for permanent or episodical pains or even be perfectly inactive, simple discovery of examination.
Its special character is to be reversible. It can the being by the setting at rest of the segment. It is it generally by the handling of which it constitutes the best indication. It can be made painless by posterior articular infiltration…
Another of its characteristics, but it is not clean, is for him to determine neurotrophic demonstrations in the territory of the corresponding spinal nerve on the side of the posterior joint pain. It is about a “” in the cutaneous territory of the nerve; it is the case in the syndrome of the dorso-lumbar hinge. They can be “cords ” in certain muscles and, finally of an over-sensitiveness of insertions. These demonstrations can be the support of local pains or often misleading women exposed to atomic radiation. The patient is not aware of it as long as they are not touched. They disappear when the responsible vertebral segment becomes again painless with the examination.
All that it is the clinical official report. The intimate mechanism of this is less obvious. One can regard it as a mini self-sustained distorsion of the vertebral segment.

. : In any case of made you a pathology of articular posterior, not really of the disc?
: The disc is surely not in the blow. It is possible that its insufficiency can support these with the lumbar level but it is less probable at the dorsal or cervical level. It does not have surely any direct role.

. : Can one consider that if handling plus the infiltration go it is the posterior hinge which is in question?
: It is true that there is no posterior articular pain-free . But is the aforementioned the cause, the consequence or simply one of the elements of the of the segment?
The ligament on and is often painful and it happens that its infiltration relieves the patient and makes disappear the symptoms.

. : The frequent success of the posterior articular infiltrations however seems in favor of a pathology of the posterior articular breakages
: Of course the posterior hinge plays a big role obviously. But the posterior articular infiltration does not relate to only the articular one. It injects also the posterior branches which posterior elements of the segment.
One can say that the success of the posterior articular infiltration, which makes disappear the demonstrations reflexes is initially a very good test. It can also bring a durable relief. But generally it does not produce a result as complete as handling when the aforementioned is well done.
I believe that the is a of the vertebral segment. The diagram is perhaps the aforementioned: a clumsy movement, a poor posture, involve a vertebral segment in an extreme position causing the pain of one of its elements, the posterior hinge undoubtedly generally, which starts one diminishes deep muscles, the rotators in particular, establishing a parasitic circuit in the harmonious program of operation . Is the aforementioned maintained all the more easily as the rachis function under the absolute sign of the trim system and that irritation is started again with each movement which requests the segment in question?
The hinge is undoubtedly intact and does not forward any lesion. But being the party of the segment it is the high speaker of these . This interpretation is perhaps completely inaccurate. But what is sure it is the of these segmentary , their consequences reflexes and of their role as regards common pains of vertebral origin.

. : People who are relieved by handling it are instantaneously?
: Yes, there are two cases of figures. The instantaneous relief is about the rule but there can be an instantaneous relief very transitory one a little reactional period follow-up and a relief 24:00 later. There is almost always an immediate change. In the successful outcomes a meeting can , but one needs on average 2 to eetings, even 5 to 6 in the very chronic cases.

. : From which does your interest for handling come?
: Certainly of a a little anticonformist spirit, and convergence of several mailmen. Being child, there was in my countryside a bonesetter who obviously relieved many wounded people. It did not make of course that miracles, but I was shocked that the local doctor doesnot can do as much of it. Older, I did much judo and the Japanese Master, hidden behind a curtain, used some secret maneuvres which seemed sometimes very effective. He revealed some with his of them, rare at the time. I was only maroon. When I had the level, it had left! But meanwhile, questioning Pierre and Paul I had reconstituted some maneuvres, and had imagined some two or three others. I was create a small system which did not go badly what enabled me to render some services to the members of the club.
I was consequently convinced of the interest of these methods. I was all the more motivated that one intended to carry on them the most incredible judgments.
They are my Masters Albert and Jean which pushed me to explore that front. They entrusted initially patients to me, then later a consultation in their services.
In parallel I was interested in the problems of Rehabilitation. Mr and Jean Pierre had done in an enormous work in the neurological field. But the things were advanced in the field of the rheumatology and csotcina.comedy, in spite of the efforts of some.
On the other hand this sector appeared much more developed in the Anglo-Saxon countries. I thus decided, fitted with a purse, to leave one year to London to look further into my knowledge in physical therapy and rehabilitation, and also in handling, since an antenna of the American osteopathic schools had just opened there. It was reserved to the European doctors. But they accepted only five pupils a year! I be likely to be allowed.
The American osteopaths hoped by developing this school to convert the European doctors with their theories, badly accepted by the traditional doctors in the U.S.A. on this point their hopes were undoubtedly disappointed.

. : There did not exist training in handling?
: There were not some in the U.S.A. in the medical schools traditional. In Europe handling was regarded as a form of charlatanism in the teaching hospital mediums. And there were very few people who were informed some in this field; they practiced them into private. I knew them the day before my departure for England. Around they tried to find osteopathy. I was all the more happy to leave for London.

. : What learned in London?
: Many things as regards physical therapy and rehabilitation and, a different manner to approach the mechanical or degenerative painful pathology of the musculoskeletal system, in particular with James .
With . , exceptional teaching, I learned osteopathy and his techniques. Very quickly I released myself from osteopathic “philosophy”, to carefully concentrate me on the manual techniques all which taught us. , become thereafter one of the outstanding characters of American osteopathy.
But what I had done before me made it possible to assimilate the techniques more quickly, to take retreat with the osteopathic theories, and even with the mode of implementation of the maneuvres which I found not very rational.
I was to thereafter propose a different system while keeping the techniques, in the limited indications which are their, and which with and we tried to specify.
But thanks to handling, I could develop a refined inspection procedure of the rachis, and consider the mechanical pathology of a different eye, even when handling is not the solution.
On my return of London, I found the service and my consultation at A. . A few years later Rene Brunet which was the chief of the service of of the Hotel God proposed me on the suggestion of Mr to organize in his service a unity of Physical therapy and Rehabilitation. This service had been created by famous Carnot which had entrusted it to , the father of the Nobel Prize.
Shortly after the departure with the retreat of Mr Brunet the administration decided to install us in new buildings which were to thereafter be by twice according to its activity because we had a strong recruitment come from all the corners of France.
The service became autonomous and I ensured the management until my retreat of it. I passed nearly 30 years to the Hospital.

. : One loses oneself a little in the United States between and osteopaths?
: The osteopaths were the first. The first school which delivered a bond of “Doctor in osteopathy” (.) was created in 1874 by . , one taught there elements of medicine and minor surgery (style officer of health). A broad place was made with the manual processing, including with the visceral massages. These had limited rights of practice. Those gradually improved with the educational level which more and more. The great stages had been the Thirties and 50. Last stage there is a score of years, the studies were strictly copied on the normal medical studies and the bond of since then allows under the same conditions as for the (Doctors of medicine), to practice all the medical and surgical disciplines. Giving up their philosophy relating to the influence of the operation of the rachis on that of the internal organs, the young osteopaths in parallel gave up handling even in the indications which appear interesting to us.
There remains nevertheless an small group which represents less than 5% and which makes a point of remaining marginal. It makes of “cranial osteopathy”, applicant to correct inter alia the deviations of the sphenoid bone and thus discussing all kinds of affections including the Down's syndrome!
To announce that in the United Kingdom certain schools deliver diplomas of which have nothing to do with the American bonds.
or . ( off ) have a legal existence, which was prone to many episodes. They practice only processing by handling and, are not authorized to prescribe. During very a long time they affirmed with an enormous publicity that the only prophylactic treatment and curative of all the diseases were the processing of the “vertebral subluxations” which they diagnosed using a thermocouple, the “”.
Recently the things evolved/moved. Their formation a little.

. : Did you attend the bonesetters?
: Attended is much to tell, but when I could meet some which had some reputation, I did it.
Those which I saw had apparently a certain good sense and a certain sense of smell to avoid the cases at the risk. As you know it is far from being general.
The practices are very diverse:
- some on false diagnoses make with skill of the sometimes useful gestures, as that which showed me a distorsion where he claimed that the fibula was moved of two centimetres behind! But its high-speed maneuvre relieved obviously the subject…
- Others make movements which are connected with a register obviously limited to certain techniques or csotcina.comedic gestures.
- Others, apparently rarer, employ maneuvres not traumatizing bearing on the muscles or the tendons. Some make thus with the inch of the frictions slow, and little repeated on the glutei, theleg ones and the muscles of the calf, for sciaticas, or stretchings short of the muscles paravertebral for cervical pains or lumbar. We have other means of making as well and even better, but that brings to reflect on the mechanism of some of these current vertebral pains.

. : What do you think of the development of medicine in France?
: I created the first in 1462 1973 in Paris VI. There are some now in about fifteen Universities in France which is besides the only European country to be had such a university education. I can only be satisfied, the more so as a unification of those is in hand.