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Editorial  |   May 2013
He Walked With Confidence Into the Wilderness of Life: A Tribute to Philip E. Greenman, DO (1928-2013)
Author Affiliations & Notes
  • Michael A. Seffinger, DO
    Dr Seffinger is an associate editor of The Journal of the American Osteopathic Association
  • Address correspondence to Michael A. Seffinger, DO, Associate Editor, The Journal of the American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864. E-mail: mseffingerdo@osteopathic.org  
Article Information
Medical Education / Osteopathic Manipulative Treatment / Physical Medicine and Rehabilitation / Being a DO / Graduate Medical Education
Editorial   |   May 2013
He Walked With Confidence Into the Wilderness of Life: A Tribute to Philip E. Greenman, DO (1928-2013)
The Journal of the American Osteopathic Association, May 2013, Vol. 113, 373-377. doi:10.7556/jaoa.2013.113.5.373
The Journal of the American Osteopathic Association, May 2013, Vol. 113, 373-377. doi:10.7556/jaoa.2013.113.5.373
In February 2013, the osteopathic profession lost revered professor, leader, and author Philip Erwin Greenman, DO (February 25, 1928-February 5, 2013). Dr Greenman, professor emeritus of osteopathic manipulative medicine and rehabilitation medicine and emeritus senior associate dean at the Michigan State University College of Osteopathic Medicine (MSUCOM) in East Lansing, was a teacher, mentor, and colleague to thousands of physicians and physical therapists worldwide during his 60-year career as an osteopathic physician. The Journal of the American Osteopathic Association (JAOA) celebrates his life and publications in this editorial. 
In 1952, Dr Greenman earned his Doctor of Osteopathy degree from the Philadelphia College of Osteopathy in Pennsylvania and went on to complete an internship at Osteopathic Hospital of Philadelphia and postdoctoral training programs at 3 different institutions of higher education. He was trained in radiology and general practice with an emphasis on osteopathic manipulative medicine. These areas were the focus of his practice from 1956 until 1972, when he was recruited by MSUCOM founding Dean Myron S. Magen, DO, to chair the Department of Biomechanics. He later joined the Department of Physical Medicine and Rehabilitation and also became a leader of the college as an associate dean for academic affairs and then associate dean. He was professor emeritus of the MSUCOM Department of Biomechanics from 1999 until his death in 2013. Dr Greenman was certified by the American Osteopathic Association (AOA) in osteopathic manipulative medicine and earned his fellowship in the American Academy of Osteopathy (AAO) in 1978; he was also certified by the American Academy of Pain Management. 
Robert C. Ward, DO, was a close friend and colleague of Dr Greenman for nearly 50 years. He described Dr Greenman as “a friend and colleague of unsurpassing excellence in his commitment to teaching, research, and public service to his beloved osteopathic profession. He walked with confidence into the wilderness of life” (Robert C. Ward, DO, e-mail communication, February 2013). Dr Ward further remarked:
 

[T]hriving on osteopathic medicine's complexity and challenges, he was a unique and forward thinking master and author of his craft, palpatory diagnosis and manipulative treatment. Teaching, writing and world-wide interdisciplinary outreach were lifelong mantras. Phil, as we all called him, occasionally reminded me that we were first introduced in 1966 at the AOA annual meeting in New York City where it was my privilege to chair the national convention program. At the time, we were early in career general practice physicians. Practicing from his home office in Kenmore, New York, Phil emphasized both general practice and osteopathic manipulative care. When needed his patients were admitted to the 31 bed Doctors Hospital in nearby North Tonawanda. As I recall, he was the hospital's administrative officer. Always active in community, national, and international affairs, his penchant for thorough preparation and in-depth engagement in everything he undertook was a lifelong hallmark. He was clean desk all the way.

 
Dr Greenman was known worldwide for his clear and expert teaching, his video educational modules, and his best-selling book on manual medicine, Principles of Manual Medicine.1 The 4th edition of this book was published in 2010, edited by a former student and long-time colleague of Dr Greenman, Lisa A. Destefano, DO, professor and chair of the osteopathic manipulative medicine department at MSUCOM.2 Dr DeStefano stated:
 

Phil had the highest integrity for osteopathic manipulative medicine. No illusions, no mysticism. To the biggest skeptics, Phil defended the role of manipulative medicine in the rational care of the neuromusculoskeletal system with amazing sophistication and diplomacy. Never daunted by criticism, he chose to teach to and learn from those that had a similar passion for normalizing joint function in three-dimensional space; which he believed was the highest compliment to optimizing ones neuromuscular behavior. It has been a great honor and privilege to watch and learn from Philip E Greenman … a true legend and a true osteopath [Lisa A. DeStefano, DO, e-mail communication, March 2013].

 
Deeply committed to teaching the basic scientific foundation of palpatory diagnosis and manipulative treatment concepts far and wide, Dr Greenman teamed with several MSUCOM faculty members plus colleagues from the AAO and the North American Academy of Manual Medicine to create a series of manual medicine continuing medical education courses for osteopathic physicians, allopathic physicians, and physical therapists. The inaugural manual medicine course, titled “Principles of Manual Medicine,” was offered in 1978. These manual medicine courses are still offered and continue to grow and thrive today. 
It was in this landmark course that Dr Greenman first articulated the unifying osteopathic concept now known as the “Five Models of Osteopathic Care,” which he elaborated on in his 1987 Osteopathic Medical News article “Models and Mechanisms in Osteopathic Manipulative Medicine”3 and in his first and subsequent editions of the Principles of Manual Medicine textbook.1,2 The “Five Models” are approaches to patient care that aim to enhance physiologic functions in 5 basic domains: structure (posture and motion), neurology, respiration-circulation, bio-energy or metabolic systems, and psychosocial arenas. The Educational Council on Osteopathic Principles and the Council of Deans of the American Association of Colleges of Osteopathic Medicine approved a curricular outline4 for use in all osteopathic colleges based on this health-oriented, functional approach summarized by Dr Greenman. Foundations of Osteopathic Medicine,5 the textbook sponsored by the AOA, identified these basic models of osteopathic care as the cornerstones of osteopathic thinking as taught by the founder of the profession, Andrew Taylor Still, MD, DO. Now, students at more than 30 osteopathic medical schools are learning the teachings of Dr Still as codified by Dr Greenman through the pages of this standard textbook. 
Carl Steele, DO, MS, was first a physical therapist student in Dr Greenman's postgraduate manual medicine courses. Dr Steele went on to become an osteopathic medical student and then a colleague, coteaching with Dr Greenman for 2 decades. Dr Steele studied diligently under the tutelage of Dr Greenman and eventually took the helm of the MSUCOM's high velocity, low amplitude osteopathic manipulative treatment postgraduate courses when Dr Greenman retired. Dr Steele stated:
 

Some of us were fortunate to have a close and enduring relationship with “Phil”. I distinctly recall my first conversation (1980) and my last, a few months ago. The word I most associate with Phil is SOLID; solid in his skills, solid in his presentations, solid in his knowledge base and solid in his commitment to the profession. There have been few individuals that have impacted my life with the force of Dr. Philip Greenman. He introduced me to the principles that I use continuously in my practice. He set the bar for my performance as a teacher and clinician. I have been truly blessed to be in the right place at the right time. Phil's legacy will endure through every patient I touch and each student I teach [Carl Steele, DO, MS, e-mail communication, February 2013].

 
Edward G. Stiles, DO, professor and neuromusculoskeletal medicine/osteopathic manipulative medicine residency director at the University of Pikeville-Kentucky College of Osteopathic Medicine, taught postgraduate courses with Dr Greenman for many decades. He recalled:
 

Phil played a major role in getting Osteopathic manual medicine accepted in the international community. Phil also played a major role in the evolution of Osteopathic Principles and Practice education in the United States. Personally, Phil had a major impact on my Osteopathic career. We initially met at the first Fred L. Mitchell, Sr. D.O., FAAO Muscle Energy tutorial. During that tutorial, I roomed with Phil and we spent many late hours discussing the amazing concepts we were learning plus the profound clinical outcomes we were observing. Our Osteopathic and educational paradigms were marked [and] altered in a beneficial way. During that tutorial Phil made several statements that positively impacted my career. The first was, “the expert is the one who does the basics the best.” That statement markedly influenced how I developed the unique [Osteopathic Principles and Practice] curriculum at Pikeville. The second statement was, “what makes a D.O. different is not [osteopathic manipulative treatment] but how they think.” Again that positively impacted my practice and educational paradigms. Phil forced me to develop a Functional [osteopathic manipulative treatment] course, in 1989, based on my experience with George A. Laughlin, DO, a grandson of A.T. Still. I cursed Phil for a year and a half as I agonized putting the course together. I never would have taken the time or made the effort to organize and teach that material if Phil had not insisted I teach that course. Phil dragged me into medical education. I eventually realized Phil did me a favor and enabled me to have a very gratifying career in Osteopathic education. This was one of many examples of the skill Phil possessed[:] of placing people in the right situation at the right time. Doing this allowed many people opportunities to realize a new and often unrecognized potential. Phil was a gentleman, a scholar as well as a great clinician. He will be greatly missed by many people and organizations [Edward G. Stiles, DO, e-mail communication, March 2013].

 
Dr Greenman authored 4 books, 68 peer-reviewed medical journal articles, 10 book chapters, and 11 educational modules. In addition, he has served on the editorial advisory board of 10 professional journals, including the JAOA. His first publication was in the JAOA in 1970: “Roentgen Findings in the Craniosacral Mechanism.”6 In all, he authored 11 articles published in the JAOA and 8 in The DO. The AAO published a compendium of his writings in 2010, titled Greenman's Works: The Collected Works of Philip E. Greenman, DO, FAAO and edited by JAOA editorial advisory board member and JAOA section editor of “The Somatic Connection” Hollis H. King, DO, PhD.7 Wolfgang Gilliar, DO, dean of the New York Institute of Technology College of Osteopathic Medicine in Old Westbury, states the following in his introduction to the collection:
 

His writings reveal his personal interests along three major spheres: Osteopathic medical education; Health care delivery systems; and Research. With regard to research, Dr. Greenman articulates three major areas that are needed for the osteopathic profession: (1) outcome measures, (2) physiological principles and (3) what it means to practice medicine through an osteopathic approach. These fundamental research questions are as valid and challenging to the profession today as they were 50 to 60 years ago; and perhaps even more pressing today given that the profession is challenged as to its need of demonstration to be unique, efficient and effective.7

 
Dr Gilliar goes on to say:
 

Read! Read! Do Read! These are the words that resonate like a mantra in my memory box. These are Phil Greenman's words he used as a well-meaning exhortation in our first ever medical school lecture at Michigan State College of Osteopathic Medicine. Study hard, ask many questions, make mistakes – and then: learn by do-ing, and then read again!

 

Little did I know that my own path would change on that cold, blistery November morning when I was invited to Dr. Greenman's office in Fee Hall at MSU to see if I could participate in translating a medical text from German to English. It was to be called “Manual Medicine.” And soon after its publication in 1984, the publisher would let us know that it had become an instant “hit.” For me the opportunity was born to learn directly authentically from the master, the expert, the “man!”

 
Dr Gilliar portrays Dr Greenman as first a gentleman, then a scholar, and finally as a catalyst:7
 

The Gentleman—Dr. Greenman embodies the essence of this word: a man of poise, refinement, and discretion. In all the nearly 30 years I have known Dr. Greenman, I have never seen him anything but calm and in full control of his even-keel demeanor. For those around him, however, this calmness quickly becomes a challenge: you innately sense that this calmness is full of potential energy. When people say he is the consummate “master” it is in the sense of true teacher, the professional: the Sensei. His actions have form and his form gives action. Action that is thoughtful, meaningful and with direction. This direction he shares with those who study with him.

 

The Scholar— … Dr. Greenman has always practiced evidence-based medicine, long before the term was a buzzword: “show me the facts, show me what you find and tell me why” he would say. When things did not fit, be it in a patient examination or in newly obtained data, Dr. Greenman would ask, “what can we learn, what is correct?” By looking at outcomes, by attempting to elucidate fundamental physiologic mechanisms (such as biomechanics, muscle and tissue physiology, structural relationships) and by studying the efficacy of the “osteopathic approach” he set course to find out what makes osteopathic medicine unique. To survive more than 120 years and to be sought after by patient after patient, there “must be something that is part of the solution, but what is it?” he would ask. The osteopathic profession is still challenged by these questions and his adherence to the scientific method is what has led to better understanding and insight.

 

The Catalyst—Be it at an international seminar workweek in a cloister in Fischingen Switzerland; where 34 of the world's experts of manual medicine convened (1984), at a sabbatical in New Zealand and Australia, or at home (Michigan or Arizona), Dr. Greenman simply builds bridges that connect. In that way, he serves as a stimulus of communication and speeds up the sharing of ideas that result in collaboration and action. By doing what he does well, he communicates the essence of the osteopathic message; by practicing what he says he gains respect; by looking forward he shares his optimism which then becomes yet another catalyst.

 
Dr Greenman received numerous honors, including the AAO Annual Lecturer Award in 1972, the Scott Memorial Lecture and T.L. Northup Lecturer Awards in 1989, MSUCOM's Walter E. Patenge Medal of Public Service Award in 1997, the AOA Bureau of Research's Gutensohn/Denslow Award in 1998, and the A.T. Still Medallion of Honor from the AAO in 2000. The American Osteopathic Foundation presented him with a Lifetime Achievement Award in 2007. In 2008, he was recognized by the AOA as one of osteopathic medicine's Great Pioneers and was presented the FAAO Distinguished Service Award by the AAO. 
He served on various committees of the AOA, including as chair of both the AOA Bureau of Professional Education and the AOA Committee on Colleges. He was a consultant to the US Department of Health, Education and Welfare and was involved in many professional medical societies. Dr Greenman served as both first and third vice president of the AOA and was a member of the AAO Board of Governors, Committee on Fellowship, and Louisa Burns Osteopathic Research Committee. 
Dr Greenman was an internationally known expert in the field of osteopathic manipulative medicine. He lectured extensively in Germany, Switzerland, Denmark, Sweden, Australia, and New Zealand. His work with the University of Otago in Christchurch, New Zealand, placed structural diagnosis and manipulative medicine into the postdoctoral course required for a diploma in musculoskeletal medicine. This program has served as a model for similar programs at other Australian universities. He collaborated with basic scientists in the departments of physiology and biomechanics to research the observations made by clinicians in the role of palpatory diagnosis. He served on the US Department of Education's Division of Accreditation and Institutional Eligibility staff in the recognition of the Council on Chiropractic Education as the accrediting agency for the chiropractic profession. He lectured at several chiropractic colleges and participated in educational research with the Los Angeles College of Chiropractic. 
Jerel H. Glassman, DO, MPH, student of Dr Greenman and colleague for more than 30 years, stated:
 

Philip Greenman led by example. He contributed original research in a broad spectrum of Osteopathic approaches from cranial to muscle energy to structural. As he became more visible in the greater medical community of neuromusculoskeletal practitioners, he formed strong relations with member of the Allopathic, Chiropractic, and Physical therapy professions. This led to collaborative projects unprecedented in the Osteopathic world [Jerel H. Glassman, DO, MPH, e-mail communication, February 2013].

 
Dr Greenman's legacy lives on in those he taught, mentored, and inspired. The collaborative interinstitutional relationships he established have been continued under the thriving leadership of MSUCOM Osteopathic Manipulative Medicine Department Chair Lisa A. DeStefano, DO, and MSUCOM Dean William D. Strampel, DO. To date, 20 residents have become certified by the American Osteopathic Board of Neuromusculoskeletal Medicine through the residency program at MSUCOM. 
The American Osteopathic Foundation recently recognized Dr Greenman's philanthropy. He and his wife Patricia gave a $2 million planned gift to MSUCOM for research. In recognizing Dr Greenman, the foundation stated, “His passion and commitment is second to none… Philip Erwin Greenman, DO, truly stands alone in the history of osteopathic medicine.” In his obituary and at his memorial service held in Tucson, Arizona, on April 13, 2013, donations for the Philip E. Greenman Endowed Residency (AS040) were welcomed. Those wishing to contribute to his legacy are encouraged to send a check payable to “Michigan State University” to MSUCOM, 965 Fee Rd, Room A310, East Lansing, MI 48824-6570. 
   Financial Disclosures: None reported.
 
References
Greenman PE. Principles of Manual Medicine. Philadelphia, PA: Lippincott Williams & Wilkins; 1989.
DeStefano L. Greenman's Principles of Manual Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.
Greenman PE. Models and mechanisms in osteopathic manipulative medicine. Osteopathic Medical News. May 1987; IV:5.
Educational Council on Osteopathic Principles. Core Curricular Outline. Chevy Chase, MD: American Association of Colleges of Osteopathic Medicine; 1987.
Chila AG, executive ed. Foundations of Osteopathic Medicine. Baltimore, MD: Lippincott Williams & Wilkins; 2010.
Greenman PE. Roentgen findings in the craniosacral mechanism. J Am Osteopath Assoc. 1970;70(1):60-71. [PubMed]
Gilliar W. Introduction. In: King HH, ed. Greenman's Works: The Collected Works of Philip E. Greenman, DO, FAAO. Indianapolis, IN: American Academy of Osteopathy; 2010:xiii-xvi.