A Treatise on the Functional Pathology of the Musculoskeletal System: Volume 1: Introduction

In this Treatise on the Functional Pathology of the Musculoskeletal System (FPMSS), Dr Brooks presents a new paradigm for understanding the musculoskeletal system and a scientifically valid-reliable, semiquantifiable, and consistently interpretable-method for examining dysfunction thereof. This first volume presents the fundamentals of the paradigm and is designed for use by a primary care audience. While the paradigm is applicable to the wide variety of clinical conditions potentially amenable to manual medicine and related rehabilitative techniques, this first volume takes chronic, nonspecific musculoskeletal pain syndromes as its focus for application.

The FPMSS paradigm complements orthopedic, rheumatologic, and neurologic understandings of the musculoskeletal system and contrasts with current models of manual medicine in several important respects:

• Understands the musculoskeletal system (MSS) as an integrated organ system
• Discriminates questions about physiology from questions about anatomy
• Discriminates questions about pathology from questions about physiology
• Differentiates functional pathology from structural pathology
• Appreciates principles of scientifically valid nomenclature for function and dysfunction of musculoskeletal structures as components of an integrated system
• Recognizes dysfunction of the musculoskeletal system as inefficient function
• Shifts the emphasis of examination for dysfunction from malalignment of structure/posture to disturbance of systemic movement
• Discriminates control of posture and movement from imbalance of available motion
• Grades available motion deficits using the criterion of proportionality-not merely symmetry-thus revealing otherwise unappreciated dysfunction and allowing for prioritization and profiling
• Prioritizes mobilization interventions according to specified, ranked criteria
• Profiles an individual's motion phenotype based upon patterns of available motion deficits, thus providing "precision" biomechanical medicine

Use of the FPMSS paradigm examination will reduce the incidence of false negative and false positive findings for MSS dysfunction-thus improving the effectiveness, safety, and efficiency of caring for those suffering from chronic musculoskeletal pain.

William James Brooks, DO, was born and raised in Fort Wayne, Indiana. He received a BA in Philosophy from Earlham College in Richmond, Indiana, where he completed his premedical training and studied critiques of then mainstream medicine along with alternative models of medicine-many of which involved hands-on care. In turn, he chose to pursue osteopathic medicine in hopes of gaining a deeper understanding of the potential value of the spectrum of medical models. He attended the Chicago College of Osteopathic Medicine (CCOM) in Chicago, Illinois, and graduated with a DO degree in 1980 after completing an additional year as an undergraduate fellow in psychiatry. It was there that he initially trained in the Chicago model of osteopathic manipulative medicine (OMM), which focused on asymmetrical movement of the spine and rib cage.

In 1981 he completed a rotating internship at Tucson General Hospital in Tucson, Arizona, after which he began a practice focused exclusively on comprehensive OMM. From 1981 through 1985, he was intensely mentored by Robert C. Fulford, DO, a renowned practitioner of osteopathic cranial manipulative medicine. Patients presented to Dr Brooks with a variety of complaints possibly amenable to OMM, but those with multiregional, chronic, tertiary musculoskeletal pain became and continue to be the major focus of his practice. Board Certified in OMM in 1991, Dr Brooks has held various academic appointments, most notably serving as Assistant Professor of Clinical Surgery in the Department of Orthopaedic Surgery at the University of Arizona College of Medicine in Tucson, Arizona, from 1989-1996. During his years as a fulltime faculty member in that department, he excelled as a clinician and sharpened his ability to effectively and succinctly communicate to his MD colleagues the scientific rationale underlying his OMM clinical practice. Subsequently, he served as an Associate Professor in the Department of Osteopathic Principles and Practice at the Kansas City University College of Osteopathic Medicine in Kansas City, Missouri, from 1996-1999, where he successfully taught an early version of this Functional Pathology of the Musculoskeletal System (FPMSS) paradigm to first- and second-year osteopathic medical students.

Currently, Dr. Brooks is in private practice in Tucson, Arizona. He collaborates in outcomes research with the Department of Orthopaedic Surgery at the University of Arizona College of Medicine as a Designated Campus Colleague and serves as Adjunct Research Scientist for the Andrew Taylor Still Research Institute at Andrew Taylor Still University in Kirksville, Missouri, focusing on adverse events of osteopathic manipulative medicine through the DO-Touch.net practice-based research network. His website www.wjbrooksdo.com provides further details regarding his background and current practice.

Challenged by his patients' suffering and inspired by his mentors at Earlham College and CCOM as well as by Dr Fulford, for more than 40 years, Dr Brooks has sought a more unified, scientific understanding of and method of examination for musculoskeletal dysfunction-toward the goal of more effective, safe, and efficient use of manual medicine and related rehabilitative techniques. In his hands and those of his proteges, the resultant FPMSS paradigm has helped innumerable patients overcome persistent and debilitating pain.