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Manifold Approach to Back Pain
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Manifold Approach to Back Pain MADAM -There has been recent debate (‘Letters’ December 1992 and January 1993), about the comparative role of physiotherapy with chiropractic and osteopathy in the management of low back pain. With regard to this discussion, I believe that the methods of mechanical therapy developed by skilled, specialist physiotherapists have much to offer, but only if they are consistently practised to a high standard. The respect and support that we currently enjoy from referring practitioners could otherwise ebb away. Currently, staffing levels in many NHS out-patient departments are not keeping pace with the demand for physiotherapy treatment. In such cases long waiting lists and management-imposed targeting policies are dictating the duration and frequency of treatment, thus compromising its efficacy. Furthermore, Ifeel we must be sensitive to the clinical ability of physiotherapists working in this field. I regard myself fortunate to have received support from my health authority and the Mcbnzie Institute to train in New Zealand for the Diploma in Mechanical Diagnosis and Therapy, since NHS funding to assist staff for external courses is pitifully inadequate. Many physiotherapists are forced to rely on in-sewice training which in itself cannot provide the necessary extent of Specialist education.
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MADAM Iwas concerned to read in the letter ‘Manifold approach to back pain’ (December 1992) the misrepresentation that chiropractorsare insisting that they are the best qualified in the field of spinal manipulation. It is unfortunate that some physiotherapistsseek to polarise views by inaccurately reportingwhat has been said. The quote used to illustrate this point was not written by any chiropractor, but by an independent New Zealand Government Commission’. This report is acknowledged, internationally, as being the most thorough investigation of the chiropractic profession. Indeed, chiropracticeducation in Britain is the most extensive education in spinal manipulation in the world. The course currently offered is a five-year BSc course with one year’s postgraduate study before registration with the British Chiropractic Association. There seems to be some disagreement even within the physiotherapy profession as to whether physiotherapists are adequately trained for spinal manipulation. Senior physiotherapists write ‘by taking short courses in manual therapy, the physiotherapistsacquired basic information on orthopaedic examination and treatment but in a haphazard and unrefined way! Applying short course information to practice, therefore, proved not only difficult, but frustrating. The physiotherapistsfound it difficult to select appropriate treatment
Physiotherapy, March 1993, vol79, no 3
The trend towards generalisation involving out-patients is also disturbing. Only a proportion of rotational senior physiotherapists have a specific out-patient interest. Such posts provide little incentive for specialist development. It is essential that as a professional body we address these issues before our techniques and philosophies are unjustly criticised. It is also the responsibilityof individuals to develop their skill and knowledge of our methods to a high standard, rather than dabble insignificantly with a variety of alternative strategems. In addition, sound research supporting our techniques would gain us considerable respect in an area where there is little or no scientific evidence to uphold any current treatment practice (Spitzer, 1987). Finally, we must co-ordlnate our use of the media to highlight, both to the public and medical profession, that physiotherapists have a leading role to play in tackling the vast problem of spinal pain.
Stephen Painting
GradDipPhys MCSP DipMM Plymouth
Spitzer, W 0 (1987). ‘Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders’, Spine, 12, 7s. measures and predict reasonable progress because they could not accurately interpret examination signs and symptoms*. Many chiropractors work closeb with physiotherapists. It is, therefore, important that facts regarding the respective professions are reported accurately. Matthew Bennett DC Spokesman British Chiropractic Association 1. ‘Chiropractic in New Zealand’ (1979).
Report of Commission of Enquiry, P D Hasselberg, Government Printel; Wellington, 3. 2. Yamada and Montague (1984). ‘Clinical education model for staff training in orthopaedic manual therapy’, Physical Therapx 64, 7, 1084-87.
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I read with interest the MADAM comments of Maureen Dennis (January, page 51) on the letter from Annabel Meayers and myself (December 1992, page 929). I would like to point out that concern regarding the limiting of spinal manlpulatlve therapy training was directed at the intentions of chiropractors and not osteopaths. I recently met with both groups locally and it was the Chiropractors who expressed the opinion that training In
spinal therapy should lie with them alone. The document we quoted was dated from 1988, but was handed to me approximately four months ago. I feel this signals the intentions of the chiropractors very well. We believe that many approaches to back pain can be successful. We stress again that we did not wish patients’ care to be limited to one type of treatment from one category alone. Patrick Hourigan MCSP Exeter
MADAM - I write in support of the letter by Annabel Meayers MCSP and Patrick Hourigan MCSP (December 1992) expressing their grave concern that chiropractors promote themselves as the best qualified profession to treat spinal problems. May I take this opportunity to make available to any interested members an excellent critical review: ‘Low back pain Randomised of mechanical origin comparison of chiropractic and hospital out-patient treatment Critical evaluation’ by Paul Lew, Jenny Keating, Professor Lance M m e y and Gwen Jull of the Manipulative Physiotherapists Association of Australia. This criticises a paper in the British Medical Journal (1990), 300, 1431-37. Members would find this paper very useful to show to other medical colleagues as it demonstrates among other points that: 1. Physiotherapists in the study did not have similar manual therapy skills. This was shown to the authors prior to the study by Peter Wells and Christine O’Donoghue (MACP reps). Attempts to change this bias were unsuccessful. 2. Patients treated by chiropractors received 44% more treatment than those in hospital and took 150% longer to complete treatment. At six weeks, 79% of hospital patients had completed treatment while only 29% had completed chiropractic treatment. 3. To say that chiropractors in the NHS would be cost effective must be viewed with scepticism, especially in cash-limited environments.
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Meayers and Hourigan also mention that physiotherapists must contlnually improve standards of treatment and assessment. This is encouraged by the Manipulation Association of Chartered Physiotherapists, and courses are frequently organised for MACP members and non-members. For further information regarding local MACP branches and the abovementionedpaper please contact me at the address below. C Robinson MCSP (Mrs) PRO, MACP Physiotherapy Department North Tees Trust Hospital Stockton on Teees Cleveland TS19 8PE
Manifold Approach to Back Pain MADAM -There has been recent debate (‘Letters’ December 1992 and January 1993), about the comparative role of physiotherapy with chiropractic and osteopathy in the management of low back pain. With regard to this discussion, I believe that the methods of mechanical therapy developed by skilled, specialist physiotherapists have much to offer, but only if they are consistently practised to a high standard. The respect and support that we currently enjoy from referring practitioners could otherwise ebb away. Currently, staffing levels in many NHS out-patient departments are not keeping pace with the demand for physiotherapy treatment. In such cases long waiting lists and management-imposed targeting policies are dictating the duration and frequency of treatment, thus compromising its efficacy. Furthermore, Ifeel we must be sensitive to the clinical ability of physiotherapists working in this field. I regard myself fortunate to have received support from my health authority and the Mcbnzie Institute to train in New Zealand for the Diploma in Mechanical Diagnosis and Therapy, since NHS funding to assist staff for external courses is pitifully inadequate. Many physiotherapists are forced to rely on in-sewice training which in itself cannot provide the necessary extent of Specialist education.
-
MADAM Iwas concerned to read in the letter ‘Manifold approach to back pain’ (December 1992) the misrepresentation that chiropractorsare insisting that they are the best qualified in the field of spinal manipulation. It is unfortunate that some physiotherapistsseek to polarise views by inaccurately reportingwhat has been said. The quote used to illustrate this point was not written by any chiropractor, but by an independent New Zealand Government Commission’. This report is acknowledged, internationally, as being the most thorough investigation of the chiropractic profession. Indeed, chiropracticeducation in Britain is the most extensive education in spinal manipulation in the world. The course currently offered is a five-year BSc course with one year’s postgraduate study before registration with the British Chiropractic Association. There seems to be some disagreement even within the physiotherapy profession as to whether physiotherapists are adequately trained for spinal manipulation. Senior physiotherapists write ‘by taking short courses in manual therapy, the physiotherapistsacquired basic information on orthopaedic examination and treatment but in a haphazard and unrefined way! Applying short course information to practice, therefore, proved not only difficult, but frustrating. The physiotherapistsfound it difficult to select appropriate treatment
Physiotherapy, March 1993, vol79, no 3
The trend towards generalisation involving out-patients is also disturbing. Only a proportion of rotational senior physiotherapists have a specific out-patient interest. Such posts provide little incentive for specialist development. It is essential that as a professional body we address these issues before our techniques and philosophies are unjustly criticised. It is also the responsibilityof individuals to develop their skill and knowledge of our methods to a high standard, rather than dabble insignificantly with a variety of alternative strategems. In addition, sound research supporting our techniques would gain us considerable respect in an area where there is little or no scientific evidence to uphold any current treatment practice (Spitzer, 1987). Finally, we must co-ordlnate our use of the media to highlight, both to the public and medical profession, that physiotherapists have a leading role to play in tackling the vast problem of spinal pain.
Stephen Painting
GradDipPhys MCSP DipMM Plymouth
Spitzer, W 0 (1987). ‘Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders’, Spine, 12, 7s. measures and predict reasonable progress because they could not accurately interpret examination signs and symptoms*. Many chiropractors work closeb with physiotherapists. It is, therefore, important that facts regarding the respective professions are reported accurately. Matthew Bennett DC Spokesman British Chiropractic Association 1. ‘Chiropractic in New Zealand’ (1979).
Report of Commission of Enquiry, P D Hasselberg, Government Printel; Wellington, 3. 2. Yamada and Montague (1984). ‘Clinical education model for staff training in orthopaedic manual therapy’, Physical Therapx 64, 7, 1084-87.
-
I read with interest the MADAM comments of Maureen Dennis (January, page 51) on the letter from Annabel Meayers and myself (December 1992, page 929). I would like to point out that concern regarding the limiting of spinal manlpulatlve therapy training was directed at the intentions of chiropractors and not osteopaths. I recently met with both groups locally and it was the Chiropractors who expressed the opinion that training In
spinal therapy should lie with them alone. The document we quoted was dated from 1988, but was handed to me approximately four months ago. I feel this signals the intentions of the chiropractors very well. We believe that many approaches to back pain can be successful. We stress again that we did not wish patients’ care to be limited to one type of treatment from one category alone. Patrick Hourigan MCSP Exeter
MADAM - I write in support of the letter by Annabel Meayers MCSP and Patrick Hourigan MCSP (December 1992) expressing their grave concern that chiropractors promote themselves as the best qualified profession to treat spinal problems. May I take this opportunity to make available to any interested members an excellent critical review: ‘Low back pain Randomised of mechanical origin comparison of chiropractic and hospital out-patient treatment Critical evaluation’ by Paul Lew, Jenny Keating, Professor Lance M m e y and Gwen Jull of the Manipulative Physiotherapists Association of Australia. This criticises a paper in the British Medical Journal (1990), 300, 1431-37. Members would find this paper very useful to show to other medical colleagues as it demonstrates among other points that: 1. Physiotherapists in the study did not have similar manual therapy skills. This was shown to the authors prior to the study by Peter Wells and Christine O’Donoghue (MACP reps). Attempts to change this bias were unsuccessful. 2. Patients treated by chiropractors received 44% more treatment than those in hospital and took 150% longer to complete treatment. At six weeks, 79% of hospital patients had completed treatment while only 29% had completed chiropractic treatment. 3. To say that chiropractors in the NHS would be cost effective must be viewed with scepticism, especially in cash-limited environments.
-
-
Meayers and Hourigan also mention that physiotherapists must contlnually improve standards of treatment and assessment. This is encouraged by the Manipulation Association of Chartered Physiotherapists, and courses are frequently organised for MACP members and non-members. For further information regarding local MACP branches and the abovementionedpaper please contact me at the address below. C Robinson MCSP (Mrs) PRO, MACP Physiotherapy Department North Tees Trust Hospital Stockton on Teees Cleveland TS19 8PE