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No Room at the CSP?
Biomechanics and Motor Disorders MADAM - As an engineer practising in the Health Service it was most gratifying to see Pauline Pope ('Letters', September) stress the importance of biomechanics when treating motor disorders. I am sure that she is quite correct in stating that the principles must be fully understood, but doubt if this is truly possible at the moment since the means of expressing pure mechanics in terms that are useful to therapists are still being developed. This is not to say that advances in therapy have not been made using the expressions of biomechanics currently available, but I do feel that even greater progress will be made if more effort is applied to establishing a common vocabulary between professionals with correct use of biomechanical concepts. As an example of language problems, terms such as 'anchorage' and 'core stability' do not have definitions which are generally accepted by the scientific community and I have great difficulty interpreting them in the context of mobility.
An example of incorrect use of mechanical concepts is provided by the reference to the centre of mass of the whole body. Centre of mass is defined for a rigid body and cannot be globally applied to a multisegmented structure without the application of restraints at all joints. This point was clearly recognised by Rose (1984) whose ideas are worthy of expansion. I am confident that improved collaboration between therapists and the scientific community is going to lead to improved treatments but this will be delayed if the language barrier is not demolished.
MADAM - It is encouraging to see a renewed interest in the biomechanics of movement as an integral part of the management of motor disorders. I both welcome and endorse Pauline Pope's plea for biomechanical analysis as a basis for effective rehabilitation ('Letters', September). However, I must offer a note of caution about the way in which these analyses are made. The major body portions are commonly considered as one unit: for example, the trunk is considered as one section, the lower limbs as another. This over-simplification can lead to erroneous biomechanical analyses with the consequence of ineffective rehabilitative strategies. The ultimate objective of rehabilitation is function in an upright vertical posture. Consideration of the biomechanics of the vertical Dosture shows that accurate motor
learning can only occur at a particular joint if there is accurate control of all joints and segments above that joint. This analysis will apply to each individual joint of the spine as well as to those joints between major body portions. Thus, consideration of the trunk or lower limbs as one unit is inappropriate unless control is known to be assured at every joint within that unit. Physiotherapists and other disciplines involved in rehabilitation have relied for too long on a simplistic biomechanical analysis. The more detailed observations outlined have profound implications for rehabilitation strategies. We must now offer our patients the opportunity to develop accurate motor control through careful joint-by-joint sequencing of motor learning.
R E MAJOR BSc CertED Oswestry REFERENCE Rose, G K (1984).'Biomechanics of gait', in: Downie, P A (ed) Cash's Textbook of Orthopaedics and Rheumatolagy far Physiotherapists, Faber and Faber, London, 43 - 60.
PENELOPE El BUTLER MSc MCSP Shrewsburv
Perspective on Manipulative Therapy MADAM - Mr R A McKenzie presents a plausible argument for physiotherapists to discard their traditional methods of treatment for spinal pain because they are unscientific, unreliable and unnecessary. He suggests replacing them with his own particular brand of mechanical therapy based on hypothetical dogma, marketing and zealot support (Physiotherapy, August 1989, 75, 8). It will be of interest to Mr McKenzie to note that at least one postgraduate course is not focused on the teaching of manual skills alone and on concepts of treatment that, once dispensed to the population, create patient dependency. At the Auckland Institute of Technology, New Zealand, a full-time postgraduate course began in 1982 in response to the need to promote advanced knowledge of the scientific principles which underlie the practice of physiotherapy (no doubt other postgraduate courses share the same philosophy). Research is therefore an integral part of the course. The manual therapy component is
Physiotherapy, November 1989, vol75, no 1 I
multifaceted, w i t h visiting lecturers providing a range of approaches to include systems developed by Cyriax, Evjenth, Kaltenborn, Janda, Maitland, McKenzie and Stoddard. The emphasis is more on understanding the rationale for the use of techniques rather than a large repertoire of technical skills, and for this purpose advanced anatomy, physiology, biomechanics, pathology, behavioural science, management, leadership and teaching skills are also included in the course. We are most appreciative of the contribution Mr McKenzie has made to physiotherapy and to the management of spinal pain, but we are also concerned about his determination to undervalue and undermine other contributions made towards t h e on-going development of the profession. JEAN BUSWELL GradDipPhys DipMT(NZ1 KATE HASWELL BSc NZRP Auckland Institute of Technology New Zealand
Save the Trees! MADAM - I feel I must register my great disappointment at Council having adopted the scheme to sell the membership list. Direct mail advertisers may well be able to acquire our names already, but this scheme would undoubtedly make it much easier for them. The carrot of helping to 'keep subscription increases down' is tempting, but what about our consciences? Can we really justify the loss to the environment of so many trees? I feel that direct mail is an invasion of my privacy, my home, and a terrible nuisance but most of all I am angered by the cost to the environment. I would .not mind a small increase in my subscription if I felt I could do my bit to provide a better environment for our children to grow up in. Of course, we will 'continue to receive a large amount of junk mail from other sources' but surely if we can stop just one company sending us this useless paper, it will be worth it. Members may like to know that they can always write to a company and demand that their names be removed from their mailing lists, but I hope most members may feel sufficiently protective towards their environment that they opt out of the Society's scheme in the first place. C E RAWDING MCSP Binbrook Lincolnshire
No Room at the CSP? MADAM - It was with regret and great surprise that the executive committee of the Manipulation Association of Chartered Physiotherapists (MACP) learnt that the new committee rooms at the Chartered Society of Physiotherapy, Bedford Row, would not be freely available to the Clinical Interest Groups for their meetings. We appreciate the need for the Chartered Society to generate funds, but it must realise that we are small groups with limited financial resources and our executive feels that funds should not be raised from the Chartered Society's own membership. Until now the MACP has relied upon the good offices of two or three establishments and we realise this must have caused them some inconvenience in the past, therefore the need for suitable meeting accommodation for Clinical Interest Groups must be obvious. ZENA L SCHOFIELD MCSP Honorary Secretary, MACP
Space Lasers MADAM - I would like to draw to the attention of all your readers that Space Lasers (formerly distributed by Benson Laser Corporation Ltd) are now distributed by Lintech. All inquiries concerning sales and aftersales service should be made in writing to Lintech at the address below or by telephone to me on 01-625 7109; I am the principal representative for Space Lasers in the UK and Eire. LINDA WILLIAMS 12 St James Mansions West End Lane West Hampstead London NW6 2AA
643
An example of incorrect use of mechanical concepts is provided by the reference to the centre of mass of the whole body. Centre of mass is defined for a rigid body and cannot be globally applied to a multisegmented structure without the application of restraints at all joints. This point was clearly recognised by Rose (1984) whose ideas are worthy of expansion. I am confident that improved collaboration between therapists and the scientific community is going to lead to improved treatments but this will be delayed if the language barrier is not demolished.
MADAM - It is encouraging to see a renewed interest in the biomechanics of movement as an integral part of the management of motor disorders. I both welcome and endorse Pauline Pope's plea for biomechanical analysis as a basis for effective rehabilitation ('Letters', September). However, I must offer a note of caution about the way in which these analyses are made. The major body portions are commonly considered as one unit: for example, the trunk is considered as one section, the lower limbs as another. This over-simplification can lead to erroneous biomechanical analyses with the consequence of ineffective rehabilitative strategies. The ultimate objective of rehabilitation is function in an upright vertical posture. Consideration of the biomechanics of the vertical Dosture shows that accurate motor
learning can only occur at a particular joint if there is accurate control of all joints and segments above that joint. This analysis will apply to each individual joint of the spine as well as to those joints between major body portions. Thus, consideration of the trunk or lower limbs as one unit is inappropriate unless control is known to be assured at every joint within that unit. Physiotherapists and other disciplines involved in rehabilitation have relied for too long on a simplistic biomechanical analysis. The more detailed observations outlined have profound implications for rehabilitation strategies. We must now offer our patients the opportunity to develop accurate motor control through careful joint-by-joint sequencing of motor learning.
R E MAJOR BSc CertED Oswestry REFERENCE Rose, G K (1984).'Biomechanics of gait', in: Downie, P A (ed) Cash's Textbook of Orthopaedics and Rheumatolagy far Physiotherapists, Faber and Faber, London, 43 - 60.
PENELOPE El BUTLER MSc MCSP Shrewsburv
Perspective on Manipulative Therapy MADAM - Mr R A McKenzie presents a plausible argument for physiotherapists to discard their traditional methods of treatment for spinal pain because they are unscientific, unreliable and unnecessary. He suggests replacing them with his own particular brand of mechanical therapy based on hypothetical dogma, marketing and zealot support (Physiotherapy, August 1989, 75, 8). It will be of interest to Mr McKenzie to note that at least one postgraduate course is not focused on the teaching of manual skills alone and on concepts of treatment that, once dispensed to the population, create patient dependency. At the Auckland Institute of Technology, New Zealand, a full-time postgraduate course began in 1982 in response to the need to promote advanced knowledge of the scientific principles which underlie the practice of physiotherapy (no doubt other postgraduate courses share the same philosophy). Research is therefore an integral part of the course. The manual therapy component is
Physiotherapy, November 1989, vol75, no 1 I
multifaceted, w i t h visiting lecturers providing a range of approaches to include systems developed by Cyriax, Evjenth, Kaltenborn, Janda, Maitland, McKenzie and Stoddard. The emphasis is more on understanding the rationale for the use of techniques rather than a large repertoire of technical skills, and for this purpose advanced anatomy, physiology, biomechanics, pathology, behavioural science, management, leadership and teaching skills are also included in the course. We are most appreciative of the contribution Mr McKenzie has made to physiotherapy and to the management of spinal pain, but we are also concerned about his determination to undervalue and undermine other contributions made towards t h e on-going development of the profession. JEAN BUSWELL GradDipPhys DipMT(NZ1 KATE HASWELL BSc NZRP Auckland Institute of Technology New Zealand
Save the Trees! MADAM - I feel I must register my great disappointment at Council having adopted the scheme to sell the membership list. Direct mail advertisers may well be able to acquire our names already, but this scheme would undoubtedly make it much easier for them. The carrot of helping to 'keep subscription increases down' is tempting, but what about our consciences? Can we really justify the loss to the environment of so many trees? I feel that direct mail is an invasion of my privacy, my home, and a terrible nuisance but most of all I am angered by the cost to the environment. I would .not mind a small increase in my subscription if I felt I could do my bit to provide a better environment for our children to grow up in. Of course, we will 'continue to receive a large amount of junk mail from other sources' but surely if we can stop just one company sending us this useless paper, it will be worth it. Members may like to know that they can always write to a company and demand that their names be removed from their mailing lists, but I hope most members may feel sufficiently protective towards their environment that they opt out of the Society's scheme in the first place. C E RAWDING MCSP Binbrook Lincolnshire
No Room at the CSP? MADAM - It was with regret and great surprise that the executive committee of the Manipulation Association of Chartered Physiotherapists (MACP) learnt that the new committee rooms at the Chartered Society of Physiotherapy, Bedford Row, would not be freely available to the Clinical Interest Groups for their meetings. We appreciate the need for the Chartered Society to generate funds, but it must realise that we are small groups with limited financial resources and our executive feels that funds should not be raised from the Chartered Society's own membership. Until now the MACP has relied upon the good offices of two or three establishments and we realise this must have caused them some inconvenience in the past, therefore the need for suitable meeting accommodation for Clinical Interest Groups must be obvious. ZENA L SCHOFIELD MCSP Honorary Secretary, MACP
Space Lasers MADAM - I would like to draw to the attention of all your readers that Space Lasers (formerly distributed by Benson Laser Corporation Ltd) are now distributed by Lintech. All inquiries concerning sales and aftersales service should be made in writing to Lintech at the address below or by telephone to me on 01-625 7109; I am the principal representative for Space Lasers in the UK and Eire. LINDA WILLIAMS 12 St James Mansions West End Lane West Hampstead London NW6 2AA
643