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Letters - 1 January 2014

Get involved now by sending your contributions by email to or write to Letters, Frontline, 14 Bedford Row London WC1R 4ED.  Letters should be no more than 250 words. Frontline reserves the right to edit letters. Please ensure you include your name, address and a daytime telephone number.

Middle ground

Reviewing some of the letters, course descriptions and discussions on iCSP with regards to pain science, it’s as if the last 20 years of integrated understanding hardly existed.

I make this point when I review some of the discussions relating to modalities/techniques and structural approaches to dealing with ongoing ‘musculoskeletal’ pain syndromes.

Reviewing the literature around all of these interventions leads to a realisation that many of the techniques being taught are unproven at best.

Sometimes it appears as if the clinical world is split between biomechanically influenced concepts of ‘dysfunction’ and new age philosophy.

The ‘middle ground’ is where the science and ‘art’ is in physiotherapy.

Knowledge and understanding gained in areas such as the science of placebo and nocebo, evolutionary biology and rehabilitation narratives, provided by writers such as Oliver Sacks, all assist in the understanding of many common modern healthcare problems.

I believe there needs to be much more emphasis and value of this middle ground in education and practice.
Ian Stevens

Board talk

I fell off my skateboard last week for the first time in skateboarding to appointments (page 9, 20 November). I wear protective gear so no injuries, apart from sore ribs. The accident was caused by a loose slab, the usual uneven poor surface.

My manager rides a Brompton bicycle, which she can take on to trains. These forms of transport should be encouraged and catered for by the transport system.

There has been great work integrating cyclists into the transport system but I think more could be done for skateboards and scooters.

All forms of green-friendly, exercise-based transport should be encouraged.
Dylan Woodhead

Burning desire

Reading George Oldfield’s article (page 23, 4 December) brought some level of relief to me as a musculoskeletal physiotherapist.

It made me aware that I am not alone in how the chronic pain state affects my level of clinical practice, and reassured me in my belief that our current standards for the management of chronic pain and central sensitisation just simply isn’t good or thorough enough.

As a result, the clinical outcomes for these patients are more likely to be poor. Having practised in both acute and community-based outpatient settings, it has become apparent that these patients require dedicated time from psychologists, physiotherapists, pain teams and consultants combined.

In theory these pathways are supposed to already exist, but so often in practice the connection breaks down and the patients are left to pick up the pieces. (In very few cases have I seen patients develop their own adequate strategies that help to resolve their pain or even manage it!)

All too often, ‘we’ refer to patients with limited or no organic cause to their pain as having psychosocial needs or ‘yellow flags’. Though these patients may not have an organic cause to their pain; it does not mean they are not in pain.

How does the brain lead us to believe that we are in pain when the healing process has taken place long before the patient presents themselves to a physio?  
Lee Barnes

Corrections & Clarifications

The new CSP vice president’s name was mistakenly given as Caroline Pope in a caption on page 18 of the last issue of Frontline, rather than Catherine Pope (page 18, 4 December). The name of the one of the CSP award winners is Michael Delahay (not Delahey) (page 17, 4 December). CSP chief executive Phil Gray gained a first class honours degree in economics at Cardiff University (rather than a first degree) and the abbreviated term for professions allied to medicine is PAMs (not POMs) (pages 24 to 28, 4 December).

You’ve ADDed...

A news item announcing that Jacqueline Brown is to chair the Associates Committee (formerly known as the Physiotherapy Associates Board) for the next two years) prompted the following comment from Sophie B:

  • If anyone has any issues that they think the CSP should be looking into for associates – the committee can make it happen.Please share with us your opinions, thoughts and ideas – we can only influence change on people’s behalf if we know what they want! Get involved on iCSP and find out what the CSP is doing for you.

Commenting on Georgie Oldfield’s Viewpoint column in the last edition of Frontline, Rachel O’Dwyer noted:

  • As a clinician working working in a multi/interdisciplinary team with complex chronic pain clients, I agree with much of what Georgie says.However, I have some doubts about to what extent the process is actually ‘reversible’, given some of the structural changes that I understand can occur within the nervous systems of people with long-term pain. It would be interesting to know if any research has been done on this, and what the views of expert neuro-physiologists would be on this one.

In response the feature on Phil Gray’s career in the last edition of Frontline,

Angela Brett stated:

  • Thanks Phil for the insight into your life. I wish you a good, long retirement. I am sure that you hand the reins over to a very capable lady who will build on your hard work.


Kim Gainsborough added:

  • Indeed you have had a very interesting life so far. Thank you for sharing your story and for all your work and commitment to the CSP. How we will miss your long and inspiring speeches at ARC and your always positive approach. Wishing you lots of exciting new challenges as you move into your ‘retirement’.

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1 January 2014

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