Editorial

Stan Innes

The year has continued to gain momentum. There appears to be more on the agenda with the passing of every week. The pace appears to be quickening and Christmas will all too soon be around the corner. The COCA executive appears to have more issues and details that require an ever increasing workload.

I admit to being a little shell-shocked after the Craig Liebenson seminar, “Utilising Neuromusculoskeletal Rehabilitation in your Clinic” Melbourne August 12^th. Despite being a nine to five day the time passed rapidly. He proved to be a very engaging presenter.

The day was started with a broad theoretical review of the “state of play in CLBP”. Dr Liebenson expressed concerns over the Biomedical Model and moved to the strengths of Biopsychosocial Model. He then reviewed several papers implicating various factors that may explain the chronicity of low back pain sufferers with high levels of disability. He concluded with the AHCPR statement “ the goal of care should shift from relief of symptoms to reduction of activity intolerances associated with pain”.

Interestingly he then prefaced outlining the day’s program by citing the Victorian WorkCover Authority Clinical Framework 5 Guiding Principles, namely evidence based, functional approach, biopsychosocial, self-care empowering and measurable outcome based.

The names of Lewit, Janda, McGill, Brugger, Hodges, Jull and McKenzie were often referenced throughout the coarse of the afternoon as he demonstrated the functional neuromusculoskeletal assessment and the appropriate interventions. Several assistants wandered through the attendees proffering valuable feedback on our attempts at assessing and implementing the stabilization exercises.

There was such a large amount of material presented that it was hard to process and fully evaluate. I would like some time to review the material, trial it in the clinical context, review it some more and then workshop smaller sections in a more critical hands on environment. It was valuable food for thought and reflection. There is a growing body of evidence to suggest that passive physical therapies alone do not constitute best practice care of those people who suffer with persistent pain and high levels of disability. The “catch cries” at present are active and self-managed care. The seminar was a source of valuable information on one approach to addressing these essential avenues that we are being challenged to integrate into our daily practice. I hope we get the chance to dissect this material further with Dr Liebenson in the future.