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The founding fathers of Western Australian physiotherapy

Physiotherapy is constantly evolving, with each dedicated generation of clinicians using guidance from their teachers to diagnose, treat and prevent healthcare issues. In Western Australia, much of the profession’s advancement and high standing in the medical, education and wider communities can be attributed to the work and efforts of four APA Honoured Members: Lance Twomey AO, Brian Edwards OAM, Bob Elvey and Max Zusman, who could be easily dubbed physiotherapy’s four wise men of the West.

For decades, intertwined with their own clinical and academic careers, they advocated for the scientific underpinning of physiotherapy, further opening it to broad avenues within research and clinical practice. Their efforts helped ensure physiotherapy was elevated to Bachelor degree status at universities. The WA Branch is keen to highlight the quartet’s input to the profession. Lance is long lauded for his leadership in postgraduate education and higher degrees by research; Brian for manual orthopaedic physiotherapy; Bob for contributions in understanding neural tension (eg, Brachial Plexus Tension Test) and inspiring others to undertake research; and Max for understanding pain, particularly a strong emphasis on the biopsychosocial model.

In February, Curtin University unveiled a plaque to honour Brian’s prominence in physiotherapy and education. He helped establish the university’s manipulative therapy program that opened in 1969, and its postgraduate diploma offering. The gown he wore when awarded an Honorary Doctorate of Science from Curtin University in 1995 permanently hangs in a display case at reception, donated to the university, along with other items. Brian later provided advice to Notre Dame University (WA) in helping set up its physiotherapy undergraduate program, says Lance.

For Curtin’s Professor Keith Hill, APAM, Head of the School of Physiotherapy and Exercise Science, remembering contributions of clinicians is important to the university. ‘Brian was a very imminent physiotherapist on the national and international stage,’ he says. ‘It’s extremely important to recognise where we have come from and who has helped position the profession where it is today.

‘Australia is at the front of the pack in terms of quality of education and quality of practice, and it’s important for today’s students to have a global picture and see how good Australian physio is and not take for granted this is physio everywhere. The primary contact for physiotherapy today goes back to the previous generation. Curtin and other institutions have been blessed with these men and other individuals who worked together and pushed the boundaries.’

Bob is credited with developing the clinical science and practice of upper limb neurodynamics for patients with neck and arm pain, with research interests in the clinical management of pain disorders. His contribution to orthopaedic manipulative therapy and physiotherapy globally saw him recognised with life memberships of Musculoskeletal Physiotherapy Australia and International Federation of Orthopaedic Manipulative Physical Therapists.

Max’s physiotherapy training began in 1953, moving into a clinical and research career helping orthopaedic and neurological patients. He is hailed as a worldwide authority on the physiology of pain and the significance of pain mechanisms for clinical practice. For 20 years from 1998, he taught at Curtin University, supervising students clinically and in research projects. Brian died in 2003, with Bob and Max 10 years later. Professor Lance Twomey went on to become the vice-chancellor and president of Curtin University. However, being called a history-maker doesn’t sit comfortably on his shoulders; he prefers to defer to the work of his three friends, describing them as ‘fine men, each with remarkable ability and talents’.

‘Physiotherapy invariably started to heavily get traction as a response to polio in the ‘50s to mid-to-late ‘60s. We all worked closely to ensure it advanced in standing to rigorous degree status that helped raise its profile in the medical profession and publicly,’ Lance says. ‘We encountered many challenges over the years in establishing a solid skills base for physiotherapists at universities that could be built on over the years. While I cannot speak for the others on whether we would do it again, I would. We formed relationships with other professionals that enabled us to help give physiotherapy solid foundations in WA, and we owe many, many people here and interstate for having faith in us and in the profession.’

The four also formed a solid friendship away from their profession, with football a shared passion and pastime.‘Of course, there was a friendly rivalry on and off the field, but you need that in order to push yourself to do better,’ says friend and cofounder of the University of Notre Dame Australia, Dr Peter Tannock AM.

‘Their reputations were often on the line for what they wanted to achieve, they were risk takers, innovators, but that is what the profession needs. We need people with passion to continue their work and advocate for the skill set that is continually being built upon and for the services we can offer to improve patient health. These four men helped form a superb health service in which physiotherapy stands tall.’

Professor Peter Hamer, APAM, from the School of Physiotherapy at the University of Notre Dame Australia, agrees: ‘We owe a legacy to these four, as well as many like individuals. They have influenced many areas that the profession now takes as granted or considered the domain of physiotherapy, when at the time of their initial influence, they were often lone voices or achievers.

‘Each is known for taking on clinical experiences and challenges and, with an inquiring mind, develop research-based explorations to explain, implement or challenge clinical management,’ Peter says. ‘They were exemplary by not just taking the accolades but by sharing their information and knowledge gained through provision of education. Each was modest in their achievements and impacts within the healthcare industry, and dedicated to educating others not only within the profession but across the disciplines of anatomy, medicine, surgery and the broad range of health-related disciplines.

‘Another common thread across each was their willingness to share and give back and this also extended to the wider community. Brian’s Tiger Moth flight from London to Perth in aid of Legacy and his volunteer work into Afghanistan for refugees and victims of land mines; Lance’s leadership and contribution across the broad disciplines in the higher education sector and his willingness to contribute, advise and make time for all—he always gets the best out of people.’

He says Max’s groundbreaking work in understanding and translating the physiology of pain resulted from the establishment of return-to-work rehabilitation programs for people with chronic musculoskeletal injury in the 1980s; adding that Bob’s work ‘opened up aspects of assessment and management that were at the forefront at that time’.

‘Max and Brian were innovative, dedicated and persistent and translated into practice what at the time was not often seen in the private practice setting. This appeared to develop Max’s enthusiasm for understanding pain. Over subsequent years I taught alongside Max at Curtin University within the postgraduate physiotherapy programs and more lately had Max lead development of an “understanding pain module” for other health disciplines.’

For Peter Tannock, the legacy of these four practitioners is a measure of character, something he is sure will endure through future generations of the profession.

‘I think the profession is in good standing, we have a high standard of quality candidates wanting to enter courses and their quality of knowledge on graduating is outstanding,’ he says. ‘If you have a passionate and knowledgeable person continuing to advocate for the profession and the patient, then we know the public can only benefit well from the work of people who helped establish physiotherapy.’

Marina Williams


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