Chronicity, Models, Gurus – and Core Skills
1
112 WE read with interest the ever- mushrooming literature and opinion on topical issues on pain and back pain revolutions and wonder which way the physiotherapy profession in the UK is heading or is being led. Such essays and reviews remind us more of Open University sociology texts than anything resembling physiotherapy. We are bombarded with articles about chronic back pain and exercise, chronic back pain and coping strategies, chronic back pain and psychosocial yellow flags. We worry that yet another iatrogenic population of patients is being created by increasing numbers of pain management clinics providing specialised treatment and management of chronic pain. In our combined 39 years of clinical experience we have come to find that a great many patients who have been labelled as having chronic back pain actually have recurrent or episodic back pain and in many cases, with a bit of help and practical advice, they find the best way of coping with it themselves. We are also asked to consider any number and variety of contemporary models on which to base our professional practice. There are models of healthcare, models for managing changes in practice, models for explaining illness behaviour, etc. It appears that academia is driving our clinical practice -- rather than clinical practice, as should be the case, providing the research questions. Academics with well-marketed well-presented arguments, often from a position of academic privilege, appear to be hijacking our professional development while trivialising -- not contextualising – clinical practice that is tried, tested and trusted (by our patients). We are informed that to follow ‘guru’ methods of clinical practice is no longer acceptable. Yet, ironically, we are advised to base our clinical practice on the great faceless 21st century ‘guru’ – evidence-based practice. Physiotherapy has always been a profession which solves clinical problems in a practical way and often from ‘beyond the textbook’. As humble clinicians we see physiotherapy as a profession of doing, listening, believing, empathising, caring, understanding, analysing, touching, sensing, moving, correcting, protecting, etc. To our patients and to most practising clinicians we believe that it is the concrete practical qualities of the profession which warrant our energies and guidance towards universal acceptance. The abstract philosophies which tend to be ‘the gospel of today’ more than likely will become ‘the heresy of tomorrow’. Even today, if physiotherapists working in pain management clinics were asked which practical measures they take to help patients with chronic pain, we are sure that many will still be using the core skills which physiotherapists have perceived and always will perceive as their domain of clinical practice, namely good communication, symptom modulation, functional rehabilitation, and dealing with problems of quality and quantity of movement. In conclusion, we believe that physiotherapists should continue to try to define the parameters of the profession more clearly. In this way the profession can develop and recognise its expertise without allowing a watering down of or lack of respect for its core skills. The physiotherapy profession is becoming more academic, that is clear. We believe however that this should not be at the expense of high levels of technical and practical skill. After all, it is no use having a bricklayer who can explain a variety of ways to build a wall but then cannot actually do the job himself. Kevin Banks BA MCSP Nancy Banks BA MCSP Rotherham, South Yorkshire Chronicity, Models, Gurus – and Core Skills I ENJOYED the article on Mitchell’s relaxation (Bell and Saltikov, 2000). However, the suggestion that diaphragmatic breathing should be avoided in supine for the respiratory patient was wrongly attributed to me (Hough, 2000). The purpose of using the problem- solving approach is to address individual patients’ problems, not ‘the respiratory patient’. If the problem is loss of lung volume, a supine position is unhelpful because pressure from the abdominal contents compresses the lungs, but the patient’s problem may be different, eg breathlessness or sputum retention. Supine positions are useful in some circumstances for diaphragmatic breathing because the abdominal muscles are not required posturally and therefore allow the abdomen to rise and fall more freely. Alexandra Hough MSc MCSP DipTP Magham Down, East Sussex References Bell, J A and Saltikov, J B (2000). ‘Mitchell’s relaxation technique: Is it effective?’ Physiotherapy, 86, 9, 473-478. Hough, A (2000). Physiotherapy in Respiratory Care: A problem-solving approach, Stanley Thornes, Cheltenham, 2nd edn. Uses for Supine Diaphragmatic Breathing Letters for publication are always welcome. If possible please send them by e-mail to [email protected]
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Transcript of Chronicity, Models, Gurus – and Core Skills
112
WE read with interest the ever-mushrooming literature and opinionon topical issues on pain and back painrevolutions and wonder which way thephysiotherapy profession in the UK isheading or is being led. Such essaysand reviews remind us more of OpenUniversity sociology texts thananything resembling physiotherapy.
We are bombarded with articlesabout chronic back pain and exercise,chronic back pain and coping strategies,chronic back pain and psychosocialyellow flags. We worry that yet anotheriatrogenic population of patients isbeing created by increasing numbers ofpain management clinics providingspecialised treatment and managementof chronic pain.
In our combined 39 years of clinicalexperience we have come to find that a great many patients who have beenlabelled as having chronic back painactually have recurrent or episodicback pain and in many cases, with a bitof help and practical advice, they findthe best way of coping with itthemselves.
We are also asked to consider anynumber and variety of contemporarymodels on which to base ourprofessional practice. There are modelsof healthcare, models for managingchanges in practice, models forexplaining illness behaviour, etc.
It appears that academia is driving
our clinical practice -- rather thanclinical practice, as should be the case,providing the research questions.
Academics with well-marketed well-presented arguments, often from a position of academic privilege, appear to be hijacking ourprofessional development whiletrivialising -- not contextualising –clinical practice that is tried, tested and trusted (by our patients).
We are informed that to follow‘guru’ methods of clinical practice isno longer acceptable. Yet, ironically, weare advised to base our clinical practiceon the great faceless 21st century‘guru’ – evidence-based practice.
Physiotherapy has always been aprofession which solves clinicalproblems in a practical way and oftenfrom ‘beyond the textbook’. As humbleclinicians we see physiotherapy as aprofession of doing, listening, believing,empathising, caring, understanding,analysing, touching, sensing, moving,correcting, protecting, etc.
To our patients and to mostpractising clinicians we believe that it isthe concrete practical qualities of theprofession which warrant our energiesand guidance towards universalacceptance. The abstract philosophieswhich tend to be ‘the gospel of today’more than likely will become ‘theheresy of tomorrow’.
Even today, if physiotherapists
working in pain management clinicswere asked which practical measuresthey take to help patients with chronicpain, we are sure that many will still be using the core skills whichphysiotherapists have perceived andalways will perceive as their domain of clinical practice, namely goodcommunication, symptom modulation,functional rehabilitation, and dealingwith problems of quality and quantityof movement.
In conclusion, we believe thatphysiotherapists should continue to try to define the parameters of theprofession more clearly. In this way theprofession can develop and recogniseits expertise without allowing awatering down of or lack of respect for its core skills.
The physiotherapy profession isbecoming more academic, that is clear.We believe however that this shouldnot be at the expense of high levels oftechnical and practical skill. After all, itis no use having a bricklayer who canexplain a variety of ways to build a wallbut then cannot actually do the jobhimself.
Kevin BanksBA MCSP
Nancy BanksBA MCSPRotherham, South Yorkshire
Chronicity, Models, Gurus – and Core Skills
I ENJOYED the article on Mitchell’srelaxation (Bell and Saltikov, 2000).However, the suggestion thatdiaphragmatic breathing should beavoided in supine for the respiratorypatient was wrongly attributed to me(Hough, 2000).
The purpose of using the problem-solving approach is to addressindividual patients’ problems, not ‘therespiratory patient’. If the problem isloss of lung volume, a supine positionis unhelpful because pressure from theabdominal contents compresses the
lungs, but the patient’s problem maybe different, eg breathlessness orsputum retention.
Supine positions are useful in somecircumstances for diaphragmaticbreathing because the abdominalmuscles are not required posturallyand therefore allow the abdomen torise and fall more freely.
Alexandra HoughMSc MCSP DipTPMagham Down, East Sussex
References
Bell, J A and Saltikov, J B (2000).‘Mitchell’s relaxation technique: Is it effective?’ Physiotherapy, 86, 9, 473-478.
Hough, A (2000). Physiotherapy inRespiratory Care: A problem-solvingapproach, Stanley Thornes,Cheltenham, 2nd edn.
Uses for Supine Diaphragmatic Breathing
Letters for publication are alwayswelcome. If possible please send them
by e-mail [email protected]
