The annual conference always creates interest for me where there are inconsistencies; rather than in the confluence of ideas that typifies the experience; I’m drawn toward the break downs; the notional clashes.
My first point of interest is the significant disagreement between speakers on the use of questionnaires. The effusive Phil Parker deconstructed a number of questionnaires in a stinging rebuke of their negative psychological focus, while Micheal Mulholland ended the conference singing their praises as fundamental tools in the management of chronic pain. My thoughts are that many of the government’s questionnaires need review and should be used selectively and even in an edited form.
Doctor Iain Bell’s presentation existed almost in a bubble all it’s own, without reference or even comprehension of the underlying message of the entire conference; that being that pain happens in the brain and that nociception in the peripheral tissues itself is not pain. Furthermore, Bell’s work didn’t even make mention of how little pathology correspond to pain and yet so much of his proposed interventions where to address pain rather than the physical pathologies that they were actually addressing.
Jim Webb, a physio who worked for Manchester City in the premier league for decades, provided a tremendous presentation on the end of cryotherapy in the treatment of acute injury. Despite Webb’s damning evidence of the efficacy of ice therapy, Mulholland wound up the conference maintaining the use of RICE (Rest Ice Compression and Elevation) for acute injury. I’ve doubted the efficacy of ice for many years and I was reassured by Webb work on the issue.
As an Osteopath I was much relieved by the final presentation on AT Still, that drew me back to the structural nature of my profession. Still believed that many illnesses can be treated successfully by normalising the anatomical structures. A good deal of the conference was about how cognitive behavioural therapy and grammatical correct communication is vital to the treatment of chronic illness. I have no issue with having a positive and amusing approach but for me our power remains in how hands on we are.
The biggest inconsistency for me was restricting the perception of pain into only two distinct types, acute and chronic. There is a complex and dynamic set of processes that weave acute and chronic pain together. Furthermore tissues we perceive to hold long term pain can be hypertonic or hypotonic, they can be cold or hot, they can vary wildly and it’s that palpatory differentiation between these states that is so very important to appropriate treatment.
Laurence Axtens - Osteopath 