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Cognitive behavioural therapy, University College London's first professor of physiotherapy Eleanor Main and manual therapy.

The profession needs a fresh impetus

I believe that we are still somewhat shackled by medical and public perceptions of what constitutes ‘physiotherapy’. Redefining our role is crucial to our evolution. One area in which the profession can take a big step is a grassroots understanding and use of psychological skills grounded within cognitive behaviour therapy (CBT). Physios can be taught to use basic CBT skills for physical health conditions (see the back skills training trial, Lamb SE et al 2010).

Suffering and distress is a human norm; some have the psychological resilience to cope and some don’t. As a general rule, physiotherapists recognise those who are likely to have a poor response to physical therapy but lack the skills to treat (Sanders T et al 2013).

Physiotherapists have a unique place in healthcare. Patients will often open up by the very intimacy of clinical practice, time, one-to one-attention, empathy and compassion. What better environment to divulge your thoughts and emotions about your physical health problem?

Used to treat a range of emotional and physical health conditions, CBT looks at the relationship between our thoughts, emotions, behaviours and physiology in the context of an individual’s unique life experience. If we are in pain, CBT recognises the key factor is how we think about our pain and then how we respond to those thoughts. We must challenge our perceptions of what defines physio and enhance our practice by better understanding our patients.

Mark Woolvine,

First for physio

I want to flag up the wonderful achievement of Eleanor Main, PhD, who has just been given a chair as professor of physiotherapy at the Institute of Child Health, University College London (UCL). She is the first professor of physiotherapy at UCL. The promotion reflects her outstanding education and research work in paediatrics and cardio-respiratory care. It will carve a path for wonderful future work and for physiotherapists. UCL is among the top 10 universities in the world and Eleanor’s promotion means a great deal for national and international physiotherapy.

Jane Simmonds, UCL

Touching response

I would like to thank Frontline for the article on manual therapy pioneer Brian Mulligan (page 12,
2 September).

As a physiotherapist working in private practice I consider myself a manual therapist. It was very refreshing to hear Mr Mulligan standing up for manual therapy. Recently I believe the ‘anti-hands-on club’ have been the ones shouting loudest online and I was starting to doubt my practice. Since attending a Mulligan Nags and snags course a few years ago I have had great results using his principles and adding them to my professional toolbox. I believe that the scope of physiotherapy should include the hands-on treatments which often provide immediate symptom relief and/or immediate changes to range of movement and so provide the patient with a window of opportunity to work on the exercises. Over the last few years I have been very disappointed by the profession’s shift away from hands-on and modality-based treatment, almost sensing a fear of physios to ‘touch’ their patients. 

I’m sure I am not alone in my thoughts and am often disappointed that few physios stand up for their opinions and beliefs against the loudmouths of social media.

Lorne Alexander

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