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McKenzie practitioners focus on approaches to back pain

Patient perspectives and debates surrounding treatments for spinal disorders will both be tackled at this year's Congress by the McKenzie Institute (UK), Mechanical Diagnosis and Therapy Practitioners (MIMDTP).

Physiotherapist Stephen May will consider 'the case against manipulation' for low back pain, looking at 'contradictory evidence' about therapy. A senior lecturer at Sheffield Hallam University, Mr May has worked in musculoskeletal outpatient care since qualifying in 1990. He has written several publications and is the co-author, with McKenzie Institute founder Robin McKenzie, of The Human Extremities: Mechanical Diagnosis and Therapy.

He says manipulation is commonly advocated for treating low back pain, even though such a 'passive intervention' may not be appropriate, and could even be harmful, given the 'natural history' of the condition. His presentation will examine the therapy in the light of epidemiology, the evidence for manipulation and 'the biopsychosocial model of pain'. Mr May will consider whether there is a subgroup of patients with back pain who might respond to manipulation.

Another presentation will ask delegates to consider a pressing question - do patients and therapists agree about back pain? Pauline Ong, professor of health services research and chair of Central Cheshire primary care trust, will compare patient and professional accounts of diagnosis, treatment and outcomes. She will show how lay and clinical perspectives can vary, and how patients assess the differences between contrasting professional approaches.

Pauline Ong has published extensively on health policy, clinical management, chronic pain, patient experiences, user involvement and research methodology. Using two in-depth case studies, she will explore issues around 'concordant/discordant' therapeutic relationships and 'examine whether greater attention to the meaning of illness leads to improved care'.

In a separate presentation, entitled 'Walking like John Wayne,' she will describe the day-to-day experience of people living with knee pain and associated disability. An analysis of diary records made by 10 individuals will show 'how people make sense of ill-health, balance professional care with self-care and develop coping mechanisms'.

Private practitioner Audrey Long will outline findings from a multi-centred randomised controlled trial into contrasting exercise prescriptions for people with low back pain. A standardised mechanical assessment monitoring pain response patterns identified a subgroup of patients based on 'directional preference (DP)' - a 'beneficial pain response to lumbar flexion, extension or side-glide/rotation testing'.

Ms Long will show how exercises which matched a patient's DP were 'highly effective' in reducing pain, medication use and self-rated disability within the first two weeks, compared with non-matched exercises. According to the study, subgroup validation has important implications for both lower back pain management and future research.

Ms Long graduated from the University of Western Ontario and has a diploma in Mechanical Diagnosis and Treatment from the McKenzie Institute.

The Lancet has just published new evidence on the effectiveness of exercise for low back pain.

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