It is with great sadness that Frontline reports the death of eminent physiotherapist Louis Gifford, whose pioneering teaching on pain science and its management has influenced a generation of physiotherapists and continues to do so.
Born in 1953, he died on 9 February. He is survived by his wife Philippa Tindle and sons Ralph and Jake. Louis had been diagnosed with prostate cancer seven years ago and outlived his prognosis.
‘His prognosis was pretty poor so living this long has been a real bonus. Louis just got on with life and lived with cancer, he definitely wasn’t a victim or sufferer – this time last year we were snowboarding in Colorado,’ Philippa told Frontline.
To his friends and patients in Falmouth, Cornwall, where he lived, he was the local physiotherapist. ‘He was very humble’, says Philippa, but to the world of pain science he was ‘one of the most influential British physiotherapists of his generation’, says Mick Thacker, a close friend who taught with Mr Gifford for 15 years.
Dr Thacker, who lectures in pain neuro-science at King’s College London and is a consultant physiotherapist at Guy’s and St Thomas’ Hospital, explains how Louis’ Mature Organism Model has contributed to today’s understanding of pain management.
Having begun a career as a zoologist, Louis later became a physiotherapist and trained with the visionary manual therapy trainer Geoffrey Maitland in Australia. ‘While there he started to understand that the traditional approaches in manual therapy weren’t helping people with chronic pain,’ says Dr Thacker.
Over seven years and a masters degree Louis developed the Mature Organism Model, which first saw light in 1998 as a paper in Physiotherapy. Louis went on to publish many research papers, including the well-respected Topical Issues in Pain series, which was re-launched in November 2013.
‘The model is a way of communicating the science of pain to both clinicians and patients,’ says Dr Thacker. ‘Previously, there was a dualistic view of pain being either physical or emotional. His was one of the first models to overcome this understanding. It still stands up today and is used by thousands of educators in the world of pain management in the UK and abroad.’
Louis’ thinking evolved into the understanding that pain is not only what is happening in a patient’s tissue but that there are multiple factors in an individual’s life that can exacerbate pain, for example, stress. ‘We now know that stress hormones can make pain worse and that by addressing the stress we can target the mechanism of pain. Previously, that pain would have been thought of as psychological,’ says Dr Thacker.
This led onto awareness of maladaptive pain, where pain may reside in the nervous system, despite tissue having healed, which ‘demands a very different treatment approach’, says Dr Thacker.
Louis’ recognition of pain as a physical and psychological phenomenon and argument against the use of single modality reasoning and therapy models for pain management and treatment have profoundly influenced practice today.
Dr Thacker believes this influence manifests in clinicians listening to patients more and taking better histories, and understanding the underlying mechanisms of pain, not just treating the symptoms. ‘For the previous 40-50 years, treatment was based on symptomatic relief, so his is a major change in physiotherapy practice,’ he says.
Louis was awarded a CSP fellowship in 2001 for his work and education in pain management. He was also a founder member of the Physiotherapy Pain Association, a professional network that is part of the wider Arthritis and Musculoskeletal Alliance.
Paul Watson, professor of pain management and rehabilitation at the University of Leicester, told Frontline that Louis was ‘one of the best and most unique communicators’ in physiotherapy education.
‘He had an incredible ability to read and assimilate complex information and put it into a form more easily attainable by others,’ said Professor Watson.
‘He was able to integrate research into physiotherapy theory and make it accessible to clinicians in a form which made sense to clinical practice, and he changed physiotherapists’ clinical practice, which can be said of very few of us.’
Professor Watson described the Topical Issues in Pain books as classics of physiotherapy literature which had, and continue to still have, an influence ‘far beyond their intended audience’ as they are keenly read by all the professions involved in the management of pain.
‘On a personal level Louis was one of the most charming, affable and generous people I have met in my professional life,’ said Professor Watson.
‘The profession has lost a true great. He enriched the lives of many; friends, colleagues and patients; he will be greatly missed.’
Natalie Beswetherick, CSP director of practice and development, says she remembers presenting the award to Louis. ‘He was so self-effacing. He didn’t think he had done anything great. His view was “I’m just a simple guy exploring some issues”.
’She adds that at the time the challenge by Louis and his colleagues of passive modalities was highly contentious, but a decade on recognition that pain is a much more complex phenomenon is part of basic undergraduate teaching. ‘He is part of the history of the profession’s changing scope of practice. He was a great chap,’ she says.
His profound influence on members is evident in the many tributes posted on interactiveCSP, the society’s member networking website.
One member comments: ‘Louis was a great inspiration. His passion, dedication, knowledge and compassion was outstanding. He was truly a tour de force in our profession coupled with his great ability to put complicated concepts into simple language for us mere mortals.’
Another says: ‘I would say he was a hero of our profession. He gave physiotherapy the strength and purpose to grab pain by the collar and engage at the frontline of care and research. He will remain so.’
Louis’ spirit and teaching will live on in a new series of four books Gifford’s Aches and Pains, which he was writing over the past year. ‘They are based on his lecture courses over the last 20 years and are expanded versions of his narrative. Louis jumps out from every page,’ adds Philippa, who hopes they will be published next month.
Mature Organism Model
To read Louis’ original article on the Mature Organism Model, in Physiotherapy, you can access the publisher’s searchable online archive via the CSP website: www.csp.org.uk/physiotherapyjournal.
Click on the blue ‘Start reading Physiotherapy journal’ button In the ‘Search for’ field type in Gifford, then in the second field choose ‘Authors’ and click on Go.
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