Editorial

Stan Innes

As the year draws to a close, I would like to take this opportunity to use the cliché “Merry Christmas and Happy New Year”. Around this time of the year I try to catch a few moments and reflect on the past 12 months and on the road ahead. It’s usually well-intentioned, but in general poorly achieved.

The most indelible memory from the year was at the 6^th Biennial Conference. On the final afternoon Professor Waddell made himself available for a two-hour “field any question from the floor” session. He has been the pre-eminent researcher in the field of chronic lower back pain. His depth and breadth of knowledge on the subject is without peer. He reflected on the current generation of treating practitioners asking, “Do we know more about the spine and spinal pain today than the previous generation”. We all nodded sagely, agreeing that this was definitely the case. He then challenged us with the question “if the incidence of lower back pain has not changed over the past generation, why have the levels of disability increased by a factor of nearly 10 in that time?”.

This led to a very lengthy silence. A voice from the crowd suggested that disability levels could be substantially reduced if people were to seek regular care / maintenance. Professor Waddell replied with a series of pointed questions.

1. Can you predict those people that will develop lower back pain?
2. If so, have you demonstrated that your treatment / intervention will lead to improved outcomes i.e., reduced levels of disability, absent days from work.
3. What message does a maintenance mindset send to the client? Does it encourage autonomy to manage, cope, and assume responsibility for their own health and well-being? Or does it reinforce the message that you have a significant weakness / disability that is beyond your control and requires a physical therapist to “fix / maintain it”.

Two other parting thoughts Professor Waddell left. The first was that we had undervalued the role of work for the injured worker. To isolate a person, by keeping them away from work to “get better”, could possibly deny them access to an environment that provides them with a sense of meaning in life and an important network of supportive relationships. He was quick to recognise that this is not always the case; work may be a place of where exactly the opposite is true. Perhaps then, part of our role is to identify those work factors that stand in the way of a worker’s recovery (yellow flags type material). He lamented the lack of research into this area and spoke of new work about to be undertaken.

Second, when asked to comment on his perceptions of possible future roles for chiropractors and osteopaths, responded by suggesting that we were not as strong as we should be in the area of functional rehabilitation. That is, perhaps it is not always possible to reduce pain levels, and if so our primary aim should be to improve our clients capacity to function in a domestic and occupational setting.

I could well be displaying my own bias by reporting on these topics. Just how holistic are we? Are we so myopic that we only notice the musculoskeletal issues? What strategies and frameworks exist in our practices to recognise and plan interventions for these obstacles to recovery? What messages are we sending to our clients? Are we encouraging autonomy and managing skills or dependency and passivity?

I hope this is some food for thought over the Christmas / New Year break. I would love to hear your thoughts on some of these topics.

Finally, I would like to thank Moore’s Legal, who will be contributing articles to address issues of importance for physical therapists in our role as an employer and also as a practitioner.

“WALSH, Michael Joseph, passed away peacefully at hospital November 20, 2005 after a long battle with multiple myeloma aged 44 years. Beloved husband, cherished friend of Helen, devoted and adored father of Timothy, Andrew and Henry. Michael was a former Registrar of the Chiropractors and Osteopaths Registration Board of NSW and latterly the Osteopaths Registration Board of NSW. Michael’s intellect, wit and ability to capture in words exchanges at Board, JEC and ACCORB meetings were legendary. He will be sadly missed. Michael was a good mate to friends at Clovelly Nippers, Clovelly RSL Snooker Club and St. Charles School Rugby League Club. A more extensive notice will be found in the next COCA News.”