Maitland and McKenzie

Changing Concepts Members were invited in the November 1987 issue of Physiotherapy to discuss changing concepts of physiotherapy. The first two letters published here are the response. MADAM - I cannot see how, in a profession such as ours with so profound a pool of knowledge, any individual can be reasonably expected to 'see the whole picture'. Specialisation - on a firm foundation of general knowledge and experience - becomes increasingly necessary in order to maintain and progress the high standards which we expect of ourselves. Intra-professionally speaking, this is news to no one. Oddly, though, it is information which we seem reluctant to spread. The medical specialist rightly regards himself as such, and accordingly so too do the public. But while many physiotherapists regard themselves as specialising, I have met none who refer to themselves as specialists. The word appears in the November issue of our Journal, but clad in inverted commas almost as though it were an apology. One who specialises must be a specialist, but we fail - at least openly - to proclaim ourselves as such. One reason for this may be a vaguely uneasy feeling that the term 'specialist' relates properly only to certain medical personnel, and that in adopting a similar designation we would be 'treading on someone's toes'. But this is unreasonable, since when we specialise we do so in aspects of physiotherapy and not of medicine. Our failure to proclaim outselves publicly as specialists engenders t w o problems. First, it robs us of a measure of the public esteem which isour due. Second, it prevents the (selfreferring) public from selecting the most suitably oriented and experienced physiotherapist. Having located 'physiotherapists' in the Yeftow Pages (so far, so good) the potential Datient is afforded no information as regards who deals with what; this is information which we, as Chartered physiotherapists, are not allowed to give. The patient is obliged to take pot luck as to whether the physiotherapist he happens to select has either a general or a highly specific knowledge concerning problems of his type. The therapeutic outcome may in consequence range from indifferent to excellent, an outcome colouring the patient's view of 'physiotherapy, rather than 'a physiotherapist'. Were I to undergo orthopaedic surgery at the hands of a dermatologist I should hardly be surprised if the result proved less than excellent. But worse, if I were unaware of any distinction between the two specialities I might, wrongly, develop a dim view of the whole medical profession. It is in the interest of the development of our profession for us to specialise, and in the interests of the public and our continued good name for us to say so. NIGEL HANCHARD MCSP York physiotherapy, Januaty 1988, vol74, no 1

MADAM - Following the ideas enumerated by the essayists under the. heading 'Where is the physiotherapyprofession going?', I should like to suggest one important area suitable for adding to our present concept of physiotherapy. Hatha yoga and its therapeutic values continue to be neglected by physiotherapists. Its main advantages are: 1. It can be varied and adapted to special needs. 2. The 'exercises' are never boring and the scope never exhausted. 3. The body acts as its own resistance and apparatus. 4. It is strongly oriented towards preventive medicine, and has a place in psychiatric treatment. 5. Regular, classes given by yoga-trained physiotherapists for referred patients could also be opened to fee-paying members of the general public. 6. All age groups can participate (from six years onwards - my yoga teacher is 77 years old). PATRICIA de SOISSONS MCSP King's Lynn Norfolk

Superintendents in Private Hospitals MADAM - Following discussions with colleagues in similar posts, ie superintendents working in private hospitals, we feel that it would be useful to have a group connecting us together. I would, therefore, be pleased to hear from others who would be interested. We could look at salary structures, service contracts, working conditions, and so on. CLARE TUHEY MCSP Superintendent Physiotherapist Gatwick Park Hospital Povey Cross Road Horley Surrey

Maitland and McKenzie MADAM - We are currently investigating thz use of the Maitland and McKenzie concepts in the treatment of patients with pain arising from problems in the lumbar spine. We should be very grateful if any physiotherapists with experience in both the Maitland and McKenzie concepts could get in touch with us. We would be asking them to complete a questionnaire on their use of the concepts and would much appreciate their help. B EVE MCSP J M TANIS MCSP Norfolk and Norwich Hospital Physiotherapy Department Brunswick Road, Norwich, Norfolk NR1 3SR

Congress Plea Answered! MADAM - As a member of the Trent Board Congress committee I read with interest the letter in the November 1987 Journal from Mr Keith Barlow MCSP BEd, in which he made a 'Congress reform plea'. Rest assured that the committee has already considered these proposals while organising 'Good Health' Congress '88. Delegates attending should find that the Congress has: 1 . Been reduced from three to two 'working' days. 2. Clinical and Occupational Interest Groups have been given opportunity to present a chosen piece at Congress. 3. General interest lectures are to be included. We are hoping that we are getting the recipe for 'Good Health' right. Why not come along to Congress '88 and see if we have? JENNIE COLYER MCSP Grantham

Enthusiasm for Orthoses MADAM - I would also like to comment on Leanie Holgate's letter published in the November Journal. The burden of her argument appears to be that it is not worth bracing and walking patients because they abandon their appliances in time. I am afraid she is rather behind these present times because questionnaires which we have sent to our discharged patients show that they do value and use the RGO a great deal more than caliper users regard their calipers. The reciprocating gait orthosis, and indeed the ORLAU hip guidance orthosis, are very much more helpful appliances and tend to be setting new levels of average usage in line with the encouragement imparted to the users. This is the key. Leonie also appears to have a limited vision of the potential for advances in design and has already decided that no matter how good the principles, the patient is 'cosmetically more acceptable in a wheelchair and the general public more accepting'. I do not think many modern capable physiotherapists would accept that imperious Victorian attitude. Neither would the patients, I respectfully suggest. Our rehabilitation partner, Steeper Orthopaedic. has now developed a lightweight orthosis to be introduced as soon as possible. It overcomes many fitting, doffing and donning problems and frictional energy losses. Very importantly, it has a remarkable, and very neat, spring leverage system which assists the lowering and /raising of the patient to and from the sitting position, under good control. This latter component, in itself, has the potential radically to change the attitudes of orthopaedic surgeons and patients alike. Please, Ms Holgate, join us in encouraging design and development.

S 0 M AUSTIN Secretary, Walk Fund London EC4 21

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