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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 towhitehousej@csphysio.org.uk