30DoS 2018 – Neil Tuttle

Although originally American, I now identify more as an Australian. By the way, the portrait is of me by a patient, not by me. In my first couple of years as a Physical Therapist in the US, I didn’t feel I knew enough or could do enough to be paid for what I was doing. I even went so far as my asking for a reduction in my pay – it was the 1970’s after all. It came to a choice of finding a way to be more effective or do something else. One venture into the ‘something elses’ was an informal apprenticeship with an 80 y/o Appalachian man making split-oak baskets and traditional chairs with hickory bark seats. For better or worse, I was accepted into what was then usually referred to as a ‘Manips’ course with Geoff Maitland in Adelaide, South Australia which after a year gave me what I considered to be a license to learn. For decades, I combined clinical practice with part-time teaching with each informing and challenging the other. In the past 20 years, I have been able to also more formally conduct research into these questions and gradually transition into a more academic role.

Some might see my research as narrow and reductionist – measuring what is felt with passive spinal movement; how such findings relate to patient symptoms and/or the mechanisms of treatment; and how to communicate these clinical skills and processes to students. To me, however, I see this as a representative microcosm. What are the conversations we have with patients? What is the physical language that forms, a significant part of those conversations? How does the physical/verbal/emotional interaction engender change – in me as much as my patients and students? I see ‘passive’ mobilisation as anything but passive – it seems to be more of an active, engaging, vibrant, interactive conversation. In the conversation, what is the difference that makes the difference? I may have more clarity about aspects of Physiotherapy than when I was younger, but perhaps more importantly, I think my questions are becoming clearer. Perhaps it is more an attitude, a curiosity. Now, more than ever, very patient and every student seems to surprise me in some way; challenges me in some way; teaches me in some way.  My biggest challenge is how to engender such an attitude in the next generation. Perhaps some of my colleagues in the Critical Physiotherapy Network will help me here, or perhaps I’m just being paternalistic to think I have something worth communicating to others.

Sir Francis Galton apparently said:

“It is difficult to understand why statisticians commonly limit their inquiries to averages, and do not revel in more comprehensive views. Their souls seem as dull to the charm of variety as that of the native of one of our flat English counties, whose retrospect of Switzerland was that, if its mountains could be thrown into its lakes, two nuisances would be got rid of at once.”

(Unfortunately, Galton was also known as the father of eugenics so it is perhaps important to select his quotes carefully)

I think as well as statisticians, the same could be said for some of our professional colleagues where reasoning is considered consist of deciding which protocol to follow because there is evidence it may, on average, be effective. I’m confident the CPN will to foster a value of the mountains and lakes.