Wednesday, November 22, 2006

Canadian Physiotherapy Pain Sciences Group

A PT friend of mine a long way away wrote to ask if I knew anyone in Victoria doing "soft, gentle" manual therapy. I knew he meant therapy that takes into account the patient, and the patient's pain perceptions, and is not just applied to their tissues as if said tissues were abstracted from the body and not connected to a nervous system, or as if the treatment of the tissues in abstracted isolation would in and of itself lead to a predictable and desireable outcome in terms of pain reduction for the patient.

Unfortunately, there is no category for such therapy. There is a category for "orthopaedic" manual therapy (pushing bones about), one for "acupuncture" (pushing needles into soft tissue, especially the sore spots, with the idea that tissue if aggravated will be stimulated to be less chronic, more acute, and finally "heal"), and various other categories for various definable conditions, age groups, or social classifications of behaviors, such as "sports"...

I settled, with a sigh, on two practitioners out of dozens listed, who had been brave enough to put themselves into a category listed as "complementary." I don't know them, or what sort of "complementary" PT they practice, but I took a chance because sometimes the unknown is less scary than the known. I also am listed as practicing in a "complementary" manner, along with "orthopaedic." To me, an "orthopaedic" listing is necessary, because it lets people know that you've studied the body in detail at least, and have acquired certain skill sets, even if you don't use them much. And "complementary" is my code-word for "willing and able to treat persistent pain problems in people."

It's a compromise.

My attempt to help my friend reminded me of why I was so interested a few years ago in helping set up a pain physiotherapy special interest group/CPA division in Canada. At the time I thought being able to present a new official category would gradually replace the one listed as "complementary", odious to many because it can mean non-orthopaedic hands-on techniques that include all sorts of anti- and pseudo-scientific hands-on theoretical constructs. Aha, I thought at the time. All these practitioners really need is access to updated pain science and neuroscience, and all will be well in PT land. The practitioners needn't necessarily change what they physically do with their hands, or how well they relate to their patients, but their thinking and understanding will take a big leap forward, and the sort of conversations they have and meanings they convey to their patients will become congruent with all that has been learned in the last decade or two. Eventually PT would be able to drop that compromising, dubious and embarrassing, even, "complementary" category in favor of the much preferable (to my mind, anyway..)"pain sciences" category.

Well, long story short, it seems the physiotherapy beaurocracy in Canada wasn't ready for such a move. Our application to become a division of CPA was rejected, tabled, postponed, moratorium-ed.

So, we decided to plow forth anyway and the Canadian Physiotherapy Pain Sciences Group was born instead. It is doing very well under the combined leadership of Neil (western Canada) and Dave (central Canada), both young with solid academic credentials and teaching experience; Deb, who is from my own era and who has revitalized her PT career by teaching pain seminars; myself, not doing much publically but always working behind the scenes, trying to help the profession get unstuck from the past.

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