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A hands-on approach

Tasmanian members will be lucky enough to hear Kim Robinson, FACP, of Manual Concepts present at their Annual Forum on 16 July, with a follow-up course being held the following day. Kim spoke with Emma Breheny about his work and the state of manual therapy around the world.

E: What will you be presenting at the TAS Forum?

K: My presentation will address the most recent research evidence for the Mulligan Concept, covering its principles, criteria for technique selection and application, and a demonstration of some of the more commonly used key techniques.

Why did you start Manual Concepts? What is its philosophy?

My colleague Toby Hall [FACP] and I started Manual Concepts back in 1994 to enrich the clinical skills and ‘hands-on’ expertise of physiotherapists here and abroad. With our experience teaching manual therapy at a postgraduate level at Curtin University, we were encouraged by former students and our colleagues overseas to teach manual therapy around Australia and internationally. Now, in addition to the courses that we conduct in Australia, we also run courses in over 20 countries around the world.

What are you noticing about musculoskeletal approaches outside of Australia?

Over the past several years, there has been a significant improvement in the standard of musculoskeletal physiotherapy in other countries and, in the last 20 years, a massive increase in the number of musculoskeletal courses on offer. Colleagues from Australia and others from different countries are now teaching internationally. Physiotherapists around the world continue to demonstrate great enthusiasm in learning about musculoskeletal concepts and approaches. This is evident in the numbers of therapists who attend our Manual Concepts courses.

Australia has, for many years, been regarded internationally as one of the leaders in musculoskeletal physiotherapy. I believe this is still the case. Many physiotherapists aspire to pursue postgraduate studies offered by Australian universities and other Australian entities.

What will people gain from attending your course in Tasmania, to be held after the Forum?

The course I’m running will focus on the Mulligan Concept, which is an exciting and effective method of assessment and treatment with an increasing amount of good research evidence for the approach. Brian Mulligan is a great man and a great clinician; we can learn much from his unique perspective on musculoskeletal physiotherapy. He has an ability to think ‘outside the box’ and this gives the Mulligan Concept a basis of feeding enthusiasm and creativity, which facilitates the evolution of manual therapy.

I believe that manual therapy has a critically important role in healthcare and physiotherapists should take the time and opportunity to learn more about the most effective and efficient methods of applying a variety of manual therapy approaches in a clinical environment.

Physiotherapists around the world continue to demonstrate great enthusiasm in learning about musculoskeletal concepts and approaches.
Are you seeing students’ training move away from hands-on therapy? Is this a good or bad thing?

I think, with the increased interest in the muscle system and a variety of psychological issues (usually associated with persistent pain disorders) over a decade or more, there has been a tendency for physiotherapists to move away from manual therapy, which is very unfortunate. Manual therapy is not just about applying a manual technique on a patient but a process of clinical reasoning, and careful and precise assessment, used to determine the most appropriate treatment approach. This process will indicate whether manual therapy techniques are indicated, if a different treatment is required or if the patient needs a combination of manual therapy and another type of physiotherapy treatment.

Manual therapy, in some instances, has been shown in a bad light by some poorly designed research that does not reflect actual clinical practice. There is some compelling evidence for manual therapy in the treatment of a variety of musculoskeletal conditions. If it is applied in the most appropriate way, most often combined with therapeutic exercise, it can be highly effective and efficient.

Manual therapy has a scientific basis and it can also be considered an ‘art’. People have to take the time to practice and become more skilful in its delivery. I have been extremely fortunate to work and teach with some great musculoskeletal physiotherapists. The common factor for all of them has been their commitment to the practice of manual therapy. They use their skills, knowledge and clinical reasoning every day. Bob Elvey, Brian Edwards, Michael Monaghan, Toby Hall, Peter Fazey, Dean Watson and Jenny McConnell are just a few that stand out. From young, enthusiastic and committed therapists, great clinicians grow.


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