How Do You Think about Physiotherapy?

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  • The softening and increased extensibil i ty of t he scars lead t o increased R6M and funct ion w h e n the scars are situated over a joint.

    The softened scars are more easily controlled by pressure; thus when used in conjunction with a pressure garment hypertrophic scars are greatly reduced.

    The gel has the elasticity of skin and moulds t o anatomical contours.

    It is easy t o apply and is cool and soothing. The mode o f act ion remains uncertain but the conclusion

    is that it releases a l o w molecular weight silicone f luid and hydrates the s t ra tum corneum (Quinn e ta / , 1985). Further research is needed to conf i rm this.

    The ful l potential of sil icone gel is yet t o be realised as new uses are constantly being developed.

    Patients are now being referred f rom other surgical departments for sil icone gel therapy t o scars developing after general and orthopaedic operations and neurosurgery. It is. also being used as bo th a conservative treatment for Dupuytren's contracture, and also post-fasciectomy, both with good effect - but no direct conclusions can be drawn until a controlled clinical trial has been carried out.


    I would like to thank Mr I McKay, registrar, burns and plastic surgery unit, Dundee Royal Infirmary; Mrs A Galbraith, senior physiotherapist, burns unit, Glasgow Royal Infirmary; and the medical photography department at Dundee Royal Infirmary, for their help in preparing this paper.


    Lamberty, B G H and Whitaker, J (1981). 'Prevention and correction of hypertrophic scarring in post-burn deformity', Physiotherapy,

    Larson, D L, Abston, S, Evans, E B er a/ (1971). 'Techniques for decreasing scar formation and contracture in the burned patient', Journal of Trauma, 11, 807-823.

    Linares, H A, Kischer, C W, Dobrkovsky, M and Larson, D L (1972). 'The histiotypic organisation of the hypertrophic scar in humans', Journal of lnvestigative Dermatology, 59, 323-331.

    Linares, H A, Kischer, C W, Dobrkovsky, M and Larson, D L (1973). 'On the origin of the hypertrophic scar', Journal of Trauma, 13,

    Perkins, K, Davey, R B and Wallis, K A (1982). 'Silicone gel: A new treatment for burns scars and contractures', Burns, 9, 201-204.

    Quinn, K J, Evans, J H, Courtney, J M, Gaylor, J D S and Reid, W H (1985). "on pressure treatment of hypertrophic scars', Burns,

    67, 2-4.

    1, 70-75.

    12.. 102-108.

    personal view

    How Do You Think about Physiotherapy?

    Senior Lecturer, School of Health and Community Studies, Sheffield City Polytechnic

    WHAT constitutes knowledge about physio- therapy? This question is at the heart of scientific inquiry. How it is answered has implications for the practice of physio- therapy, its effectiveness and its status.

    If Physiotherapy Journal is to deal adequately with the complexities of physio- therapy, we have three problems, at least, to think about: the seeming intractability of explaining physiotherapeutic phenomena; the theoretical complexity of knowledge about practice itself rather than techniques; and the need to identify strategies and techniques of empirical investigation appropriate t o different styles of physiotherapy.

    Research is like treatment: choice of techniques is dictated by strategy, and choice of strategy is constrained by the techniques which are available and feasible, and it is rarely independent of a general methodical standpoint.

    My particular gestalt of physiotherapy does not need to command universal assent. Whether or not you perceive physiotherapy to possess qualities as a whole that cannot merely be described as a sum of its parts, it is clear that there are many different styles of physiotherapy, from the more formal reasoning and practice of, say, spinal and peripheral mobilisation practitioners to the holistic approach of, say, physiotherapists caring for elderly people.

    The outlook of the former is representative of the physiotherapist who works within a single, well-defined, self-consistent paradigm and has a view of physiotherapy which embodies, among other things, a style of conducting and recording an examination, a preferred logic to interpret the findings, and a set of precise techniques to fulfil the aims of mobilisation.

    The latter has a different style of reasoning and model of care, placing feeling and thinking in the same framework in order to serve both people and physiotherapy itself by enhancing the service to a section of humanity.

    Between the two are several types of physiotherapist, such as the 'neurophysio- therapist' who accepts that there is no single, precise, internally self-consistent paradigm to treat all the problems he or she is presented with and has recourse to multiple conceptual possibilities, even explicitly conflicting paradigms. Neuro- physiotherapists thrive on conflict: it is both the beginning and the sustenance of treatment.

    Just as we recognise that there are different methodological approaches to and styles of physiotherapy so there are different methods and styles of the research. Their purpose is to direct and guide inquiry, not to constrain it. However, judging by corres- pondence, comment and reports in

    Physiotherapy, there is a conflict between physiotherapy as a caring profession and physiotherapy as a biomedical science.

    At the holistic end of the spectrum, the caring profession is associated with qualitative methods of inquiry, disparagingly rejected as 'soft'; the other end is associated with 'hard' scientific-reductionist methods of inquiry.

    These differences are neither strengths nor weaknesses but have created a tension of such an intensity that they can no longer be ignored. They should be acknowledged for what they are, signs of basic differences in logic, style and temperament of fundamentally different ways of perceiving practice and conducting research.

    Physiotherapy emerged in a fragmented way from massage, Swedish remedial exercises, and 'light and electrotherapy', with a healthy contribution from physical education. The possible consequences of continuing and increasing disparity are dire unless we make both the reasons for diverging views explicit and a conscious effort to understand them.

    Contrary to what some text books and research advisors suggest, no single, unified cut-and-dried method exists in research any more than it does in physiotherapy and no one style of inquiry occupies a privileged and preferred position.

    In order to achieve a unity of purpose, methods and knowledge, we must recognise where older, established styles of research are appropriate and where the emerging, less well-established styles of inquiry might be better able to capture the essence of physiotherapy.

    A case has been made for peer review of papers for Physiotherapy but it should not be used to suppress, consciously or unconsciously, papers in which the style of inquiry does not conform to some preferred form. I expect that the Journal Committee aims to make Physiotherapy as acceptable to lndex Medicus as Physical Therapy is; but it would be doing physiotherapy and physio- therapists a great disservice if its views of acceptable methods of inquiry were so narrow and rigid that it rejected all other logics and styles than the one it prefers.

    physiotherapy, April 1990, vol 76, no 4 197