Guest spot this week: Mark Andrews of Kemptown Osteopathy in Brighton has kindly allowed me to use the full version of his review of Aches and Pains (an edited version appearing in the latest “the osteopath” magazine). He did in fact put me on to this book, written by a late, great physio called Louis Gifford. Don’t be put off by the fact the author’s a physiotherapist – it transcends professional boundaries and speaks directly to any manual therapist.
Aches and Pains. Louis Gifford. 2014. CNS Press
Aches and Pains is a unique piece of work written by Louis Gifford, a highly respected
physiotherapist and early proponent of the Biopsychosocial (BPS) model approach to
musculoskeletal pain and dysfunction. It was published posthumously last year by his wife Philippa
Tindle, also a physiotherapist, and is partly autobiographical with detailed pain neuroscience,
philosophy and illustrative case histories.
Aches and Pains is in fact three books weighing in at 1319 pages and is the culmination of more
than 30 years practice, research and lecturing. The first section which carries the same title as the
collection sets the scene with Gifford’s early years in the NHS, meetings with Patrick Wall and
foray into the physiotherapy world of Australia where he met Geoff Maitland and David Butler
amongst others. His idiosyncratic style of writing is deceptively simple and engaging and before
you know it you are sucked into the neurophysiology of the dorsal horn, placebo, nocebo and
memory biology. You are then introduced to Gifford’s own Mature Organism Model (MOM) of
human neuro-immune function via the medium of the Numskulls (a classic comic strip for those of
a certain age and a childhood favourite of mine). The MOM is arguably Gifford’s most influential
construct, recently described by Prof Mick Thacker as incorporating biology, ethology, the Neural
Matrix perspective, need state, stress biology and neurophilosophy! However as with the rest of
the book he manages to present this model in an easily accessible and digestible style. The first
book then ends up with a look at nociception, healing, tissue adaptation and stress.
On to the second part of the trilogy, The Nerve Root, which as the name suggests is accented
towards the function of the nervous system both central and peripheral. The “trendy” brain and pain
are discussed in detail, all the time with Gifford’s irreverent sense of humour, but don’t be deceived
by his tone, the text is detailed and exacting and scattered with clinical gems. The sections on
discs and peripheral nerve injuries are indispensable and of great relevance to osteopathic
practice, including an exquisite description of a journey through the anatomy of the lumbar spine as
if you were exploring the space from the inside.
The final book entitled Graded Exposure draws together the threads developed in the earlier
chapters into models for patient management. The MOM is developed as the Vulnerable Organism
Model when under threat and there are discussions of the biomedical and BPS models amongst
others. Again the text is littered with gems for clinical reasoning and approaches to treatment. The
whole series ends with a wonderful collection of case histories which triggered some “aha”
moments and often made me smile.
If there were to be any criticism of this tour de force it could be levelled at the lack of formal
referencing system and indexing. However, chapters are followed with a page of “Read What I’ve
Read” suggestions, listing books and studies that have either been referred to or were influential in
Gifford’s thinking. I would suggest having a pen and note pad handy while working through the text
to make notes of key information and page numbers.
So who should read this book? In my opinion if you use your hands to treat people in pain then you
can’t afford not to buy it. It is both relevant if you have just started your career or are at a point of
reflection and re-evaluation after years in practice. A word of warning however, sacred cows are
slaughtered and gurus questioned, if you want to avoid cognitive dissonance then don’t pick it up. If
however you are interested in a paradigm shift towards a modern, evidence based approach to
musculoskeletal pain and dysfunction I cannot recommend it highly enough.