The International Federation of Manual Physical Therapists (IFOMPT) held its quadrennial meeting in Glasgow, Scotland July 4th to 6th. For those of you who have not experienced an international conference, I highly recommend it. This conference is an exciting time to advance ideas, learn skills and gain insight on how physiotherapy (physical therapy) is practiced in different parts of the world. Also, it is a chance to catch up with friends and hear presentations from very high caliber therapists and researchers. Plus, if you have not been to Glasgow, it is pretty amazing!
Such a large conference is difficult to summarize in one article, so I will provide several posts over the upcoming months, specific to each of the lectures I attended.
I have to admit; I was skeptical of the theme of the conference “Expanding Horizons.” Physiotherapy in the past decade has been focusing on research of pain mechanisms and clinical prediction rules, so I felt that the horizons of therapy were contracting, not expanding. My thought was that the conference was going to focus on a lot of hands off material, disproving manual therapy and promoting “talk therapy” and, in some ways it did. But speakers like Ann Moore, Gwen Jull and the always entertaining Brian Mulligan provided balance to the ever growing chorus of critics to specificity and high level manual therapy.
Ann Moore started off the conference, providing insights into the current state of therapy. She made an interesting comparison of physical therapy care of extremities and the spine. She pointed out that while there is a concordance of approaches in the assessment and management of extremity disorders, this is not the case with spinal management. She stated in a tongue and cheek manner that we have one spine, two arms, two legs and one common brain. Meaning, we have one spine, which appears to confound us, as opposed to the four extremities, in which we have a clearer path of treatment. Then she mentioned a person with chronic pain from hip OA is treated in a different philosophy from one who has chronic pain from L5/S1 and poses the question why??
She did not provide a lot of answers, but she did make some observations. She took the biopsychosocial model and listed certain basic features of each component. The biological features include …
- Pain Mechanisms
- Neuromuscular Disturbances
- Sensorimotor Disturbances
- Movement and Kinematic disturbances.
If structure has a strong relationship to function, it appears that the mechanisms of function are listed above, but not the structural components, nor, the potential for structural dysfunction.
In summary she mentions that we have goals for both extremity rehabilitation and spinal rehabilitation.
- Prevent reoccurrence
- Prevent transition to chronicity
- Slow disease progression
She again poses the question, “if we have the same goals for both, why do we approach them differently?”
One of her answers was the ever favorite, “more research is needed.” But she did state that pain relief is not an indication of neuromuscular rehabilitation, and with that I wholeheartedly agree. Pain relief is just the start!
After the lecture, in the Q&A section Ann was asked about the discrepancy of different approaches to treatment of the spine. She stated …
“We have serious mechanistic research ahead of us, but we have to look at what treatments are doing.” Her goal is greater clarity with the approach to the spine in the biopsychosocial model.
When asked specifically about different approaches and the effectiveness, Gwen Jull answered the question with the following statement.
“The research of manual therapy approaches shows that there is similar impact to different approaches, finding a commonality in the neurophysiological effects. What you have to do is learn to do it well and at a high skill level. It is the skill that is important, and the dilution of manual therapy skills is worrying.”
In conclusion, she stated that we will miss the big game if we fight between models and, in the process, not advance our skills in manual therapy.
Just attending a conference of this magnitude makes you want to learn and practice at a high level. And I am encouraged to teach for an organization that has promoted high level physical therapy for over 20 years.
More to come about other presentations and some exciting insight into nerve entrapment, shoulder assessment, updated research regarding hypermobility syndromes, cervical artery disease and the always entertaining Brian Mulligan.
– Terry Pratt, MS, PT, COMT, FAAOMPT
Fall Manual Therapy Courses with Terry Pratt:
Cervical Spine I (Touro College NYC) +7 hrs Online, September 18 - September 19, 2016 in New York, NY
Terry is a Faculty and Clinical Fellowship Instructor for The North American Institute of Orthopaedic Manual Therapy and has lab assisted with the Institute since 2002. He’s served as adjunct faculty at several universities, developed teaching manuals for the McConnell Institute faculty, produced technique videos for NAIOMT, formatted and reviewed the textbook ‘Manipulative Thrust Techniques of the Spine’ by Erl Pettman, and the manual for distance mentoring for NAIOMT clinical fellowship instructors and fellows in training. Terry has written a section for a home study course for the Orthopedic Section of the APTA addressing treatment of the injured lumbar spine published in 2015. Learn more.