President's Report

Peter Werth

Now that we are on the other side of the 6^th Biennial Conference I have been able to reflect on the messages that were presented very eloquently by our speakers, and in particular our keynote speaker Professor Gordon Waddell. As we all know too well chiropractors and osteopaths have a diverse range of philosophies regarding what we do, from the “crisis care” approach to managing mechanical back pain to the philosophy associated with wellness care and encompassing the specific management of vertebral subluxations. However, unless I am practising in a vacuum detached from the reality of the rest of the profession (which I doubt), most of the patients that consult me attend for management of their pain, mostly spinal pain.

Therefore, if you strip away all of the philosophical debates and attempts to define the lesion that we treat, our role is to help people deal with their pain, and in turn help them to return to normal function, or as near as is possible. Some practitioners choose to take it further and address their health further via a wellness approach, but usually that is not what has initially brought the patient through your door.

If we accept this scenario, that we are the managers of patient’s (spinal) pain then I would question our role as “experts” in the field of treating spinal pain. Before you tear up this issue of COCA News and bin it, hear me out. What we usually do very well is manage acute and sub-acute spinal pain, and this is supported in most part by the available evidence. Our main form of treatment remains manipulation or the adjustment, and the evidence shows that this is efficacious in the management of back and neck pain in the early stages following onset. What has become quite evident, and was certainly highlighted at the recent conference, is that managing pain effectively takes more than a purely mechanical approach to finding and treating subluxations or somatic dysfunction. There are numerous factors that impact on a patient’s perception and ability to deal with their pain, and in particular the biopsychosocial factors as described by Gordon Waddell and others play a significant role in the patient’s progress through their episode of back pain. This is usually further complicated if their back pain is associated with a compensable injury, such as a work place injury. By having a narrow focus on the mechanical aspects of pain ie. focusing on the subluxation, disc lesion, facet syndrome or the like, and promoting the need to treat the “lesion” we may be contributing to the patient’s problem rather than assisting them overcome it. For some patients this approach has the potential to promote illness behaviour, and increase their level of disability rather than assisting to reduce it. In other words - we may become an integral part of the problem, rather than part of the solution.

In the case of chronic pain the regular ongoing delivery of whatever manual treatments you choose to use is not well supported in the literature. Treating patients with chronic pain should differ significantly from managing acute and subacute pain - if you practice according to the current evidence.

This is where we, (and might I add, nearly all practitioners who use any form of manual therapy) fall short in any claim to be an “expert” in treating chronic spinal pain. What works for one phase of the injury will not necessarily be applicable to all phases. Chronic pain is a different beast to acute and sub-acute pain, and hence its management needs to be different too. A “hands-off” approach via the use of exercise, cognitive behavioural strategies appears, at this point in time to be the most applicable approach to managing chronic pain spinal pain. This form of rehabilitation is where the management of these patients is at right now. If you like… rehabilitation is the new black. Rehabilitation is now getting considerable attention at the undergraduate level in most programs in Australia, with Murdoch University recently opening a state-of-the-art rehabilitation facility. Integrating this active management approach into our practises although somewhat challenging, as we need to move out of our comfort zone to some degree, is in my view essential to advancing the chiropractic and osteopathic professions in the 21^st century. This has been the primary focus of our continuing education program of recent years and will continue to be so going forward.

No matter what your spin on practice the advantage of this approach is that it sits very well with most practice-styles and at the end of the day will provide you with better outcomes and an enhanced reputation as the “expert” in managing all phases of spinal pain.

We all want to do the best we can for our patients, and so I would urge you to consider how you choose to treat your patients, and what messages you give them as part of your educational spiel - are you helping or hindering them in the longer term?

As noted above the 6^th Biennial Conference has been and gone. It proved to be very successful with a great variety of speakers and excellent content, including our research session, which has been established to allow chiropractors and osteopaths involved in research have a forum to present their work to their peers. The standard of presentations was exceptional, and it will now become a regular fixture in the COCA conference program. The poster session also added to the research flavour of the conference and this too will be added to the conference programs in the future. Thanks to Drs Bruce Walker and Melainie Cameron who were the drivers of these initiative.

The other speakers at the conference were excellent, including our Executive members Henry Pollard and Melainie Cameron who are at the forefront of the professions in this country. We are indeed fortunate to have them actively involved at Executive level providing great leadership and support. Our keynote speakers Gordon Waddell and Mitch Haas were both extremely well received and were an absolute delight to meet and chat with at the conference. Both have a great insight into the management of musculoskeletal pain, and have a wonderful perspective of the big picture issues facing the professions globally. Those of you who had the opportunity to speak to them will know what I mean.

Please refer to accompanying articles in this issue summarising the presentations at the conference.

The year has again sped past at an alarming rate (I’m told a sure sign of ageing), so on behalf of our Executive and staff I would like to wish you well for the festive season and the New Year. I would like to thank the Executive and the staff for their continued hard work and support. If you are having a hard-earned break enjoy the time with your families and friends.