A Hands-On Approach toMusculoskeletal MedicineAn Interview with Robert A. Schulman, M.D.

By Anne Hendren Coulter, Ph.D.

Ann Hendren Coulter: How did youbecome involved in complementarymedicine?Robert A. Schulman: I have a degree

in dance and theater from the NaropaInstitute, which is now the Naropa Uni-versity in Boulder. At Naropa, I wasexposed early on to Tibetan Buddhistmeditation and Tibetan Buddhist philos-ophy. The type of dance and theater Istudied there was personal and explo-rative. I studied improvisational theaterand postmodern dance, which is basedon what movements the body can do notnecessarily what movements look goodon stage. This was, so to speak, my ini-tial introduction to the body-mind inter-action.A few years later, I was living up in

Ithaca, New York with two other guys.During the winter, a Hindu swami (His

Holiness Shi Mahant Swami GaneshandaBaba) came to live with us. Baba was fromthe Kria Yoga line, and he taught us thebreathing techniques, which are very rig-orous. He laughingly called us lazy chil-dren, and encouraged us all to becomephysicians. Two of us went on to becomedoctors and the other one went on tobecome a physical therapist. So that wasall—that was very interesting and some-

what formative, I would say. Before Iwent to medical school, however, I wentto massage school in Santa Fe, New Mexi-co, fully intending to go to naturopathicschool. The school in the Southwest wasnot functioning at that time. I began toteach t'ai chi chuan, the Yang style as

taught by Professor Chen Man Ching—amartial art that I had learned at theNaropa Institute.My t'ai chi students—many of whom

were acupuncture students or acupunc-turists from Santa Fe—exposed me toacupuncture as a profession. I moved toSan Francisco to attend the American Col-lege of Traditional Chinese Medicine. Ienrolled there and prepared to start class.I actually woke up one morning and knewthat I had to change my mind. I went backto school at San Francisco State and tookpremed courses. I considered going toosteopath school, as that would allow meto use the manual medicine skills that Ihad acquired in massage therapy and as adancer. But I resisted this, thinking Ishould probably be as mainstream as pos-sible since I already had acquired so manyalternative skills. I'm not sure whetherthat was a mistake or not because I reallyfound medical school to be somewhat of astruggle.AHC: Why was medical school such a

struggle?

RAS: Well, like the surgeon who revealedthat surgery interfered with her spiritualgrowth, much of medical school wasappalling to me. This surgeon said that shewas no longer able to cope with the waypatients were treated in the operating room.

There is a lack of holiness, lack of respectfor, the patient in the operating room. Manysurgeons don't appreciate, or even recog-nize, the privilege they are being given tocut a person open. It troubled me. Anotherthing that made me uncomfortable was theway we treated our cadavers. Of courseeveryone has their own issues about this.The professors taught that we were given a

privilege of these people donating their bod-ies and that we should respect the bodies.But there was something missing I thought.And then, of course, being a medical stu-

dent in a hospital, you're treated like you'rea moron. So, it was really, hard to maintainthat sense of reverence, you know, for theprocess of becoming a physician. It wasn'tuntil I finished my residency in physicalmedicine and rehabilitation and had takenthe UCLA [University of California LosAngeles] acupuncture course run by JosephHelms, M.D., that I came in touch withphysicians who had experience dealingwith complementary medicine. I thenrecovered some of the respect for patientsthat I found was somewhat lacking in themedical community. This is not to say thatevery medical doctor is completely heart-less. Not at all. In general, however, medicaltraining doesn't allow for that.

AHC: So I've heard.RAS: Once I lit the fire of the UCLA

thing, I came back into my own. Iregained my manual medicine skills. Itook a few more courses and I could begintouching people again. I recognized that Ihad the information I needed to practice

87

Robert A. Schulman, M.D. is an Amer-ican Medical Association-certified special-ist in physical medicine and rehabilitation,and an associate professor of rehabilitationmedicine at Cornell University's WeilMedical College, New York City. In hispractice, also in New York, he has inte-grated acupuncture, manual medicine,Traditional Chinese Medicine, and theFeldenkrais Method® with conventionalallopathic medicine for treatment ofpatients with musculoskeletal and otherdisorders. Alternative & Complemen-tary Therapies interviewed him to learnhow he came to integrative medicine andhow he hopes to use it in his practice.

I may use acupuncture for example, which iswonderful for acute conditions such as ankle andknee sprains, contusions, shoulder problems, and so on.

Robert A. Schulman, M.D., at his facility inNew York City, shown with some of the natu-ral medicines he uses.

medicine and started using a lot moremanual medicine in my practice.AHC: Hence, you got into rehabilita-

tive medicine?RAS: Yes. I think I always wanted to be

a physical medicine rehabilitation special-ist because of my background in move-

ment and massage.

AHC: Rehabilitation medicine is a spe-cialty ofmedicine, now, isn't it? Physiatry?RAS: Yes. Physiatry has been a board-

certified specialty since the 1940s. It was a

very low-profile specialty until recently,probably because of insurance issues. Inthe fifties, and sixties, and early seventieseveryone made money as physicians. Itdidn't matter whether you were known inthe community; physiatrists primarilytook care of inpatients. It was common forspinal-cord-injured or stroke patients tostay in the hospital for 3-6 months, oreven longer. Some spinal-cord-injured

people would stay in the hospital for a

year. Because it was reimbursed, rehabili-tation medicine was in great demand.

AHC: My experience with physiatristsis that they treat stroke and headinjuries. Is that what you are doing?

RAS: Not so much, no. I primarily treatoutpatients. Two branches of physiatryseem to have developed since the special-ty was first approved. One type of physia-trist becomes a physical medicinespecialist, the other does more rehabilita-tion in the hospital. I tend to see almostexclusively outpatients—musculoskeletalpatients—from the physiatry point-of-view. I have expanded my practice toinclude patients who also have internalmedicine problems as well. But as a physi-atrist, I primarily practice musculoskeletalmedicine. I occasionally will see someonewho has had a head injury or a strokeafter that person has stabilized. They willcome to me for additional treatment.

AHC: What kinds of patients do yousee?

RAS: Like most complementary physi-cians, I see people with chronic pain or ill—ness, people with back, neck, andshoulder pain or with inflammatoryarthritis. Oftentimes patients are misdiag-nosed or unclearly diagnosed. As a physi-atrist, I may make a slightly differentdiagnosis, treat accordingly, and theyoften get better. I may use acupuncture forexample, (which is not practiced by allM.D.s), which is wonderful for acute con-ditions such as ankle and knee sprains,contusions, shoulder problems, and so on.

I have a few people with chronic prob-lems that aren't going to go away and Isee them every 2 weeks. That seems to sta-bilize them.

AHC: What are those chronic prob-lems, for example?RAS: One of my patients has had

insomnia for about 10 years. He works toohard and he's sort of driven. It's not formoney; it's for a sort of personal gratifica-tion that he works so hard. He works twofull-time jobs and I have been trying tohelp him with alternative prescriptions.AHC: What do you use as treatment?RAS: I have been giving him prepared

Chinese herbal formulas. Several compa-nies sell these—Three Treasures [WalnutCreek, California] (which is primarily forconstitutional illness), K'an Herb Compa-ny [Scotts Valley, California] (which can befor more acute disease and also for consti-tutional illness), and Health Concerns. Ibuy only the formulas that have been pro-cessed and inspected in either the UnitedKingdom or the United States. Some Chi-nese patent medications, that have notbeen processed or inspected in these coun-

tries, have been shown to be adulterated.

AHC: What other types of alternativemedical products do you use?

RAS: I use some homeopathic remediesbut am not formally trained in homeopa-thy. I typically use packaged products likeBHI/Heel, Trameel (anti-inflammatory),Vertigoheel (vertigo, dizziness), and Zeelfor arthritis (containing Arnica montanaand Rhus tox) [all from Heel, Inc].

ALTERNATIVE & COMPLEMENTARY THERAPIES—APRIL 2000 89

The Feldenkrais Method is a wonderfulway to reeducate the neuromuscular system.

I also use some supplements, such as

glucosamine sulfate, chondroitin sulfate,and SAM-e [S-adenosyl-methonine]. I useipriflavone for osteoporosis, and coen-

zyme Q10 for high blood pressure. Youknow, as I learn about a supplement and Ifind that there is some good literature tosupport it, then I'll use it.

AHC: Do you treat patients using yourother skills, like dance and tai chi?

RAS: I don't so much. I do have a physi-cal therapist who works for me using theFeldenkrais Method. She has been withme

about a year. Prior to that, I would take thepatients out in the waiting room, whichwas the largest room in the office I wassubletting, and show them some exercisesto do. It's very tedious and I wasn't reallygetting reimbursed for it. But, you know, itwas clearly what they needed. Now, afterthe person has had some acupuncturetreatments, I'll suggest that that person seethe physical therapist as well. TheFeldenkrais Method is a wonderful way toreeducate the neuromuscular system.

AHC: How do you handle reimburse-ment? Some physicians have droppedpatients with insurance.

RAS: I started off part-time about 3 l/2years ago and I've been full-time formyself since May. So I'm not really in a

position to refuse insurance. I've droppedout of a few programs that pay so littlethat I couldn't really afford to maintainthem. Insurance is a pain. This morning Iwas on the phone for 45 minutes with a

company. It didn't pay for the initial officevisit and it didn't pay for the physical

therapist's initial evaluation. Typically theadjuster will say: "Oh, we made a mis-take."

AHC: Aren't you affiliated with Cor-nell University?RAS: Yes. I have a clinical faculty

appointment there. I occasionally teachresidents.

AHC: In alternative medicine?RAS: No I teach electrodiagnostics. I've

been more involved with teaching residentsat St. Vincent's Hospital in lowerManhattan[New York City], because the departmentchairman somehow found out about what Idid. Several years ago I taught a 10-hourcourse to the residents on acupuncture andhave also given lectures to the general pub-lic there. I just did another lecture for theresidents and attendings on acupuncture.The department chairman is open to havingthe residents exposed to acupuncture.

AHC: How do New Yorkers respond toalternative medicine?

RAS: New Yorkers are very receptive tothese new medical techniques. New York-ers, particularly in Manhattan, feel that theylive at the center of the universe. Somethings are somewhat dictated by style andfashion, and some aren't, you know. But Ithink that New Yorkers tend to pride them-selves on being on the cutting edge. Andcomplementary medicine is sort of the dar-ling of that. Two, if not three, major institu-tions are opening huge outpatient centers.Beth Israel, under the direction of WoodsonC. Merrell [(M.D.)], is opening a center veryshortly; and there is the Midtown Center

Images of the famous bronze acupuncturestatues in the facility's waiting area.

for Complementary Care, which is fundedby Complementary Care Foundation and isdirected by JeryWhitworth [R.N., C.C.P.].AHC: Speaking of donors, who is

funding your practice?RAS: Me! I work! I don't have a secre-

tary, it's all done on a shoestring. I savedup for about a year-and-a-half to open thepractice full-time. I take very few vacations.I get in the office at 8:30 or 9:00, and I'mhere until 9:00 o'clock.

AHC: About how many people are inyour practice?

90 ALTERNATIVE & COMPLEMENTARY THERAPIES—APRIL 2000

I have an herb cabinet out in the waiting room so

people can look in and see what the herbs in my practice look like.

Patients can look in this herb cabinet in thewaiting room to see what the herbs in Dr.Schulman's practice look like.

RAS: I'll see maybe thirty-five people a

week—thirty-five, forty people a week. Andit's taken me about 3 years to build that up.

AHC: While you have been buildingthis practice up over several years, isn'tthis facility relatively new?

RAS: I opened it at the beginning ofNovember. It's my first full-time office. Iquit my hospital job in May—I was themedical director of a holistic medical cen-ter in Westchester County, at UnitedHospital in Port Chester [in New YorkState]—and I left that job in May. Plan-ners are still investigating how a comple-mentary facility will work in that locationand meanwhile I wanted to practice. Icontinued my practice in Manhattan andhad an office available to me 3 days a

week. Three days a week I worked and,then the other two days, I looked for an

office. I am glad to be working on myown, because it is difficult to work withinthe structure of any hospital. All hospi-tals are just learning how to integratecomplementary medicine into theirinfrastructures.

AHC: Given this experience it wouldseem that your affiliation with CornellUniversity was not something you were

seeking.RAS: I actually did want the appoint-

ment. I was first a clinical instructor, andthen I edited the November 1999 edition ofClinics ofNorth America, Physical MedicineRehabilitation North America on Complemen-tary Therapies in Physical Medicine andRehabilitation. After this was published, thedepartment chairman asked me to join thestaff as an assistant clinical professor.AHC: What does your facility look like?

Have you avoided creating an office thatresembles a conventional medical facility?

RAS: Yes and no. It's in a pre-World WarII building. When I found it, I pulled up some

of the tiles in the floor and found out thatthere was wood floor beneath the tiles. Iasked the managing agency: "Is it okay if Ipull up the tiles?" It said: "Oh, yeah, youknow, but there's going to be a lot of concretepatches." The entire suite is wood floors! Themost beautiful thing you've ever seen. I spent2 days on my hands and knees pulling thetiles up to save a few thousand dollars.Because of thewood floors the colors are sortof very muted. It doesn't look at all like a doc-tor's office. It's very calming and relaxing.AHC: So you don't have anyone sitting

in front; it's just a waiting room?RAS: Well, sometimes someone sits in the

front, like a temporary employee. But youwalk into a little waiting room where thereare images of the famous bronze acupunc-ture statues. The legend is that these wouldbe covered with wax and filled with oil. Stu-dents would have to place needles into thestatue and cause the oil to drip out, provingthe correct location of the acupuncturepoint. I have an herb cabinet out in the wait-

ing room so people can look in and see whatthe herbs in my practice look like. Eachroom has a very sturdy table, a cabinet forneedles and what not, a few chairs, and a

mirror. It's not a sterile environment. I don'thave the typical, "doctor sink" with thethings that make everyone nervous aboutgoing to the doctor. The physical therapyroom is a huge room with a wood floor. Thetherapist has her table in there, and we use italso as a movement studio.

AHC: Tell me about the physicaltherapist.

RAS: Her name is Chris Griffen, [P.T.] andshe's both a physical therapist and a

Feldenkrais Method instructor, and a blackbelt in Aikido. She has a wonderful sense ofmovement and is very grounded in her ownbody. Another woman who will join us soon

is Lauree Wise, [O.T.] an occupational thera-pist who practices something calledBody /Mind Centering. Body/Mind Center-ing is a technique developed by Bonnie Bain-bridge Cohen, [O.T.] also an occupationaltherapist. The technique uses an organ sys-tem approach and helps people to supportmovement through the organs and organsystems. Thismight include the skeleton andmuscles, but also the internal organs, theblood and lymph system, and the cellularlevel systems as well. Body/Mind Centeringis different from the Feldenkrais Methodbecause the former is based on developmen-tal movement patterns—the patterns that aninfant goes through. Oftentimes a reason

people have chronic pain in the muscu-

loskeletal system is that they may havemissed acquiring a developmental pattern ata young age. Bonnie has a beautiful phraseto express her work. She says: "The mind islike the wind, the body is like the sand. Ifyou want to know how the wind is blowing,look at the sand."

ALTERNATIVE & COMPLEMENTARY THERAPIES—APRIL 2000 91

"Alternative" medicine is a wordthat we're all trying not to use very much.

I also send people with significant emo-

tional issues to a woman named Sue Brennerwho practices the Rosen Method of body-centered psychotherapy. This is a greatmethod because, as Marion Rosen is fond ofsaying: "The body clearly reveals what wemost often try to hide." It's a very gentlemethod that can be extremely powerful.AHC: What is the attitude of allopathic

physicians versus alternative physiciansin New York?

RAS: Well, I think that we are all hard-pressed to earn a living as medical doctorsthese days. I think that reimbursements are

constantly going down, and paperwork isgoing up, and insurance companies are beingmore and more restrictive. So, I think physi-cians view any competition to their ability toearn a living as suspect. When you takesomething like Chinese medicine—whichhas very effective ways of treating colds andflus and chronic indigestion—disorders forwhich allopathy doesn't really have much inthe way of treatment—the allopaths, I think,are rightly afraid that their patient populationwill go to these complementary practitioners.Allopaths also seem to feel that comple-

mentary physicians do not evaluate our

patients properly.AHC: So the diagnosis is incorrect?RAS: Or it's superficial. It's very interest-

ing because we feel as medical doctors thatwe should be able to bill for a medical treat-ment and the acupuncture treatment whenwe bill insurance. So we bill for an officevisit and for the acupuncture, because if a

patient comes in with cancer, for example, Itake a history and review her records. Eachtime I see her, I have to determine whether,in fact, an acupuncture treatment and herbsare still appropriate, because she has cancer.

I'm held accountable to a somewhat higher

standard, than a non-physician acupunctur-ist. Not that a good acupuncturist wouldn'tnecessarily know if things were gettingworse, but just that medical doctors are

going to be held to a higher standard,whether it's true or not.

I think that the perception in the allo-pathic community, perhaps, is that comple-mentary medical physicians are not goingto be practicing as high a level of medicineas are those practicing only conventionalmedicine. I don't think that's true.

AHC: What is the future of alternativemedicine?RAS: Well, first of all, I like to call it

"complementary medicine." "Alternative"medicine is a word that we're all trying notto use very much. I think that the public ismuch more aware of its own health. Peoplecome in with supplements that they'veresearched on the Internet. I had a patientcome in recently who was on antidepres-sants, but had heard of SAM-e. He knew as

much about SAM-e as I did. People can goto Web sites, they can find this informationout. People want to be more involved intheir health care. When someone comes in, Isay to that person: "You are causing yourpain, this back pain didn't come from yourfall down the stairs, or something. Yourreaction to your own internal Stressors andreaction to the external environment areperpetuating this pain. It's not until youlearn what it is that you're doing that's cre-

ating the pain, that you'll be able to let itgo." Not everyone is ready to hear that, butmore and more people are looking forsomeone to tell them that. From my branchof things, that's why complementarymedicine is growing.AHC: How will this affect its future?RAS: The critical mass of complemen-

tary practitioners is growing. The UCLAacupuncture program runs 700 physiciansthrough every year now, which is a

tremendous number—they're thinking ofexpanding it to 1000. There are about10,000 or more licensed acupuncturists inthe United States, and the number is grow-ing all the time. The small little guilds,such as the Feldenkrais, Alexander,Träger, Body/Mind Centering, and Rolf-ing guilds are also growing, and the publicperception of them is much greater. All ofthese small communities of practitionersare beginning to come of age, so to speak.The public is recognizing that, yes, allo-pathic medicine is very important if youhave cancer, or you break a leg, or you'rein a car accident, or what have you, but itslimitations are in the chronic diseases thatwe don't have a lot of good treatment for.

So, I think the future is quite bright.We are working under economic pres-sure. American industry believes that thereason the economy is so good is that ithas broken the back of the medical indus-try, which I think is patently untrue. Butcorporate America has never beenstronger, and yet the health care industryis in major trouble. Hospitals are reallydoing very poorly. We're all strugglingwith that—complementary medicine andmainstream medicine, alike. But I thinkour future as complementary physiciansis—well, I think we are the future. Tech-nological biomedicine will continue toadvance, and we will advance right alongside. D

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