In the world of spinal Physiotherapy, we share the turf with
chiropractors and osteopaths. This has been very irksome for us over the years
because we consider ourselves medical, and them not. However, the sad
reality is that back pain is often dealt with better outside the realms
of Medicine - and by this I mean through Osteopathy and Chiropractic.
This may be, in part, because of the highly litigious world we operate in, but I believe Medicine (and by this I include its able helper Physiotherapy) is extremely cautious - really, too cautious - about tangling with back pain. And in doing this, or perhaps not doing more to the point, we are letting our patients down.
You only have to look at the National Health Service site in the UK dedicated to back pain to see a lot of talk about red and yellow flags, together with well-mannered comment - something to the effect that ‘physiotherapy can be good for backs’ - to realize that there’s not a lot of rolling up of sleeves going on and a sense of engaging with the problem.
Of course part of this is because the problem is so huge. Back pain is really a vast and ever-growing problem of pandemic proportions worldwide, so it’s not surprising that the good old NHS is keeping, well . . . rather ‘hands off’ about it all.
I believe this is a great shame. Indeed, a physiotherapy graduate in one of my recent Masterclasses in the UK told me that her local Area Health Authority in the north of England had issued a directive that physiotherapists were not to touch their patients in their spinal physiotherapy treatment. The reason given was that ‘it made them too dependent’. Instead, these poor patients - who’d often been on one waiting list or another for months - were to be handed a generic set of exercises on a piece of paper. My goodness me, I say! Is this what our spinal Physiotherapy has come to? (You can click here to see a similar article on this.)
It would seem that while the United Kingdom was the birthplace of Physiotherapy in the earlier parts of the last century, it will now, in the interests of costs savings, be the graveyard of Physiotherapy in the early parts of this one. You can read in the UK Physio magazine 'Frontline' an article about this sad initiative.
Quite apart from the fundamental departure from the original essence of our professional charter, it will be the demise of Physiotherapy within the NHS in the UK. It will see patients flooding over to private practice and to other hands-on therapies that do still touch their patients. Indeed, this may be the cynical objective of health commissioners within the NHS but the costs will be high, with an end of the teaching culture within the public hospital system.
In many instances Osteopathy and Chiropractic are doing better than we are. Yes, over-servicing may seem to be a common feature of their practice - and we certainly hear a lot about that - with patients in some instances being urged to sign up for a year of spinal treatment (yes, that’s right, twelve months!). No doubt this is because most, if not pretty well all, osteopathy and chiropractic is carried out in private clinics, where there may not be the incentive to educate patients to help themselves with self treatment for their back pain.
A propos this very point, I had a patient the other day who’d had a recent epiphany in his chiropractor’s waiting room. A photograph had appeared on the wall congratulating Joe Blow for being their most faithful patient for the last 20 years! With the practitioner all smiles (I can’t vouch for the hapless patient) it certainly was clear to the man who became my patient that he had to do something himself, if he wasn't to end up in the same boat. With stunning clarity he realised that surely there must be something he should be doing himself in self treatment for his lower back pain.
And of course, there is always the clinical question of whether or not it’s counter-productive to repeatedly manipulate a back problem with Grade V manipulative thrusts - the typical popping or cracking sound one hears with spinal manipulation - which many in back pain Physiotherapy circles believe to be the case. I don’t agree with this carte blanche since I believe, in some instances, manipulating a lower back is the only way (though here’s not the place to discuss it) and I applaud chiropractors and osteopaths for having the skill and the aplomb to do it effectively.
To carry out the typical on-your-side lumbar manipulation a practitioner needs strength, coordination - and yes, a certain amount of flair - although some in the spinal physiotherapy world talk of this disparagingly as the ‘million dollar roll’. Many fortunes are made from this. So there you are . . . . I guess you’d have to include me in the brigade of people who’re a bit sniffy at this monotonous and unimaginative approach. I guess, for me the question is whether manipulation is used appropriately.
And finally, before I go, I should also say that I applaud the
chiropractors and osteopaths for their courage in manipulating spines,
because back pain physiotherapists are often (I suspect) fearful of
doing this. I say this because a fairly
effective scare campaign has been waged over the decades by the Orthopaedic
Medicine world, about how dangerous it all is (albeit more for the neck)
which I do not believe to be the case.
So here we go. Part of me writing these two websites simplebackpain.com is the other) is to urge change in the world of Physiotherapy too, not just urging patients with back pain to take up their bed and walk. We need to take up the cudgels in so many fronts, not least rolling the sleeves up more in bringing relief to our patients – and I believe we could do well, in some instances, to take a leaf from the books of our main competitors on the turf.
Meanwhile, you might be interested in a good overview: a thinking physio's take on 'where physiotherapy is at' by Professor Peter o'Sullivan, a New Zealand academic working in Perth WA, combining research with clinical time with patients.
For more articles on spinal physiotherapy from Sarah Key click on: