A reflection on MACP placement learning by Sean Case

Sean Case: identified his pre-placement learning needs and discusses how these were met during placement.

1. Identify and evidence the severity and irritiability of a clients presentation prior to objective examination using evidence from subjective

2. Following the above then identify and be clear about limit of symptom reproduction for all symptoms ie before P, onset P, 50% P, all P

I worked on these two by articulating my thought processes and justifying these to the clinical educator after the subjective ax and before embarking on objective assessment – then depending on the pt or the scenario I might then articulating my thought process during the objective assessment or discuss with the clin ed afterwards about this. Then we would build on this with subsequent visits for that pt. Discussion with the other student also helped this and self reflection.

3. Ensure reassessment of all markers subjective and objective incl functional after intervention and at beginning of subsequent session.

Through discussion with clinical educator and my self reflection I was able to identify the value of this process and how it influenced the progression/regression/adaptation of treatment and also how it helped create a common langauge between physio and pt.

4. As it was an Upper quadrant placement I was keen to experiment with the use of active ULNT as a correlatorry examination to passive ULNT. This was to try and make my assessments more functional and meaningful to the pt.

This was acheived through having the opp0rtunity to treat patients with neurogenic neck and arm pain in a situation where I had time to explore and practise and reflect with other clinicans of greater experience. This type of change of practice whereby I have greater confidence to move away from standard procedures and to adapt and modify according to the pt and their presentation has been one of the fundamental shifts in my practice through the MACP placement process

5. Indentify and consider dominance of pathological presentation under the headings of articular/neuro/myofascial. To then use evidence from client assessment to justify interplay of these tissues in the patients presentation and order of priority for treatment. To utilise this relative dominance to support hypothesis generation but to also avoid closing hypotheses down to soon.

As above having the time and oppurtunity to explore and bounce ideas around with a more experienced clinician as well as the other student helped me develop and learn to keep hypotheses open as well as to re-evaluate as treatment progresses. ( still working on this one – when working with a busy full list it can be easy to slip back into definitive one tissue source mindset)

6. A key learning aim for me in the communication aspect was during the consultation to avoid repetition of statements or constant rephyrasing and to say something ONCE and wait for a response.

Again feedback from other student and Clin Ed help me reflect and develop my communication interactions with patient (and others!)

7. Another key overarcing learning aim was to be more aware of my responses to criticism – ie to be aware of whether I am being defensive or impulsive with responses during post patient analysis discussions or when being confronted by challenging questions about my practice.

8, To be myself and to demonstrate my normal practice

This improved by concious effort as well as through recognising the value of being critiqued. This accepting and opening myself to alternative perspectives and suggestions has made me much less defensive about my practice and reflects a change in mindset from their being ‘one way’ or a ‘right way’ to do things to their are many ways. Importantly by demonstrating my normal practice I am being myself (not what I think the clinical educator wants me to be) and can therefore learn from my actual practice not an impersonation of my practice

My Journey: How clinical placement helped to become a patient centred practitioner.

My name is Kostas Kasimis and I am about to finish my MSc Neuromusculoskeletal Physiotherapy course in University of Brighton. I have recently finished my second clinical placement and I would like to share my experience with you.

Before starting this placement I was feeling confident.The experience of my first placement and the progress I made there, added confidence to me as a clinician.Adding to that, the fact that I had already worked with my clinical mentor during my first placement and he knew my strengths, weaknesses and needs as well as the fact that we had worked on fundamental issues already made me feel a lot more secure and at ease. At the same time I was feeling nervous as I knew that the secondplacement, which is the final step before you become an MACP member, would be more challenging and that my fellow student would be a very experienced and skillful clinician. I was feeling that although it would be a tough and challenging experience, it would be a great opportunity to push myself and develop myself even further as a clinician. I felt that I would have the chance to improve my time management, to enhance my clinical reasoning skills and to become more efficient in exploring and addressing patient’s psychosocial contributing factors.

When the placement started I felt much more relaxed. Soon after the beginning of the placement I felt that we were a great team. My fellow student and I were helping each other by giving honest feedback and sharing our knowledge. The observations by the mentor were made in a relaxed way without the “fear” that you are being observed. Sometimes we were discussing during the session about patient’s problem which was great because you had the opportunity to have their perspective and improve your thinking process. I wasn’t nervous any more. I realized that this is a great learning environment for me. Individualized and honest feedback, conversations about our own worries and thoughts, jokes, “games” to facilitate learning and promotion of deepreflection were making the environment relaxed and great for learning. We worked on several different issues that I had to address regarding my clinical practice. I was suggested by the mentor to become less “Greek” which means that I should forget that I am the “expert” and interact with the patient as he was my friend (but always in a professional way). This patient centered approach was different to the approach that I had to my patients in Greece. It was a cultural issue that I had to address. The most important thing is that I managed to do that without changing myself. I found that interacting with the patient in a more collaborative way suits me very well – it was me. At same time I realized that this is the best approach in order to provide efficient management to patient’s complicated problems. I also realized that if you treat the patient like they are “passive” to the expert opinion they remain passive throughout the whole rehabilitation process. If you have them on board from the beginning, if you try to make them feel that they are contributing to the decision making for their problem then they become much more active and they participate actively to their rehabilitation.

Another thing that became apparent to me during my placement was the importance of being flexible and adaptable. I realized that if you are able to understand your patient as soon as possible you can build an excellent rapport with them by showing them a version of yourself that suits them best. In that way, they feel more relaxed and it is more likely to share their thoughts with you as well as give you more accurate information about their problem. For example, it is more likely to build a rapport with a young patient if you use more common language, if you are more laid back and relaxed while you might need to avoid “slang” terms with older patients who appear to be more serious. Similarly,sharing common experiences or interest with your patient might be a good way to enable them to talk more about themselves, about their thought and experiences. This is my understanding from my interaction with patient on placement.

Another issue that we tried to fine tune was that I tended not to put context in my questions or actions during the subjective or physical examination. Sometimes I was struggling to establish a good relationship with the patient or I had poor results on my treatments (or tests)and I realized that was due to lack of context of my questions and actions. I learnt the importance of “taking” the patient with you on the “journey” of the examination and treatment. I learnt how important is for them to know why you are asking all those questions, why you are applying those tests or treatment techniques. It became clear to me that if you prepare them and set them up for what you are going to ask or do it becomes much easier for them to follow the whole process and most importantly to become active participants to that process – you have them “on-board”. Just to add that by explaining and preparing the patient for the upcoming question or action you help your thinking process and your clinical reasoning as well – which I found really helpful. It is like you and your patient think together about their problem. This is really a patient centered care.

I think that the relaxed environment that the mentor created in addition to the thorough and in depth productive feedback that I received by my mentor and fellow student facilitated my learning. I also believe that the deep and honest reflection on my practice as well as the identification of my strengths and weaknesses were the key points that enhanced my learning. Identifying and revealing your weaknesses and being able tohonestly reflect on your own practice might be really difficult in the beginning but soon it becomes the strongest tool that a clinician has in order to keep developing himself. Finally, the fact that I had a great collaboration with my mentor and my fellow student -we were a great team together- added a lot to my learning experience.


MACP Educational Bursary

MACP Educational Bursary


In an era of increasing restrictions on funding streams available to support educational conferences I was lucky enough to apply and was successful in obtaining an educational grant from the MACP to attending the 8th interdisciplinary world congress on low back and pelvic pain held in Dubai this October.


Landing in Dubai early Sunday morning I was excited about the 4 day programme with the overarching theme of promoting advances in multidisciplinary research for better spinal and pelvic care.


Arriving I was hit not only by the heat but by the excellent conference organisation by Andry Vleeming and his team. With nearly a thousand delegates from over 56 countries, registration, food and facilities were excellent and the experience of this international conference has reassured me the IFOMPT 2016 in Glasgow has already planned all the key ingredients needed for a successful conference.


Day one started with an excellent talk from Peter Reeves prompting us to think about spinal stability with an interactive lecture on lessons from balancing a stick. This lead into research looking at the role of fascia and it’s major role in effective load transfer. These points were reinforced both by anatomical dissections revealing the extent of fascial interconnections but also real time ultrasound studies of the global action of all core muscles through fascia rather than isolated muscle working.


Day two highlight for me was the session lead by Paul Hodges exploring plasticity in both the sensory and motor system and how we may influence the process with neuromodulatory techniques.


Day three highlights for me included lecturers from Maurits van Tulder discussing cost effectiveness of primary care interventions on LBP providing background knowledge on the methodology used in looking at cost effectiveness. This was new knowledge for me will help me question more closely decision made on treatment selection that affect my practice within the NHS.


This talk lead nicely to Margreth Grotle who explored outcome measures in research and clinical practice and the use of patient specific functional scale or patient generated index to help validate our practice.


Day four, with conference fatigue slightly setting in, the audience gathered to hear the final talk on antibiotic treatment to patients with lumbar pain. After the recent news interest in this research it was nice to have a chance to discuss the research with the main author Hanne Albert. An excellent engaging speaker she held the audiences interest to the very end of the conference and has made me think about the new sub category of chronic pain LBP patients.


Although the draw of the conference was the selection of speakers in the main conference sessions I would encourage all people attending conferences to stay for the parallel sessions. Although short, these 10 minute sessions provide an insight into the direction of back and pelvic pain research within the International community.


As I boarded the plane after the gala dinner on the Thursday night I had time to reflect on the take home messages for me from the conference. My understanding of fascia and it’s foundation / structural  role in mechanism of movement control has increased. As a trainee MSK sonography student I leave excited about starting to use this modality to look more closely as the fascial and myogenic system within the body.


The enthusiasm of the people presenting the conference and the continued debate that extended well beyond the conference to the pool and the many restaurants in Dubai has renewed my interest in becoming active in post graduate research. As I land in Cardiff thoughts have already turned to PhD studies and the possibility of someday presenting my own research to the international MSK audience.


I would encourage all members to apply for these bursaries and visit the MACP website for information and closing dates for applications.


Helen Welch


Nikki Petty visits Parliament to represent the MACP

Visit to the House of Commons………..on MACP business!

Nikki Petty

Clair Hebron kindly(?!) asked me to represent the MACP at the National Arthritis Week 2013 Parlimentary Reception from 1-3pm on Wednesday 9 October 2013. Chris Mercer was originally invited (they were not up to date with the change in Chair) and because the MACP AGM was the day after, Clair was unable to go. This didn’t sound up my street, but it was a day out and something different, so I agreed. I turned up early outside and just as well as there was a long queue of people going in for various functions, and here was I thinking the red carpet would be out. I got chatting to the man behind me who happened (!) to be the chief executive of the Natural History Museum. What does one say after ‘weather is nice and do you come here often?’ (and yes he did come here often). I was clearly punching above my weight. Thankfully the lady behind me joined in who was also some high flier strategist who had just come for the DoH…………don’t ask me anything more as not quite clear what she did do, whatever it was it was very, very clever. He was off to a different function but before we parted our ways his top tip to me in ‘working the room’ was to just get stuck in and introduce yourself to people and don’t be afraid to interrupt; ok helpful advice I thought. There was high security to get in (hence the queue) with all the equipment of an airport. The security lady opened up my lipstick (I’d left it in my pocket and so was handed to her rather than go through the xray machine)- wondering what on earth she thought she would find – and then eventually said ‘like the colour’! Oh the British dry humour, how I love it.

Well finally got through and on to Dining Room A, to arrive almost bang on time. This was a small thin rectangular side room but with plenty of drinks and nibbles at one end, a makeshift stand/stage in the middle and a photo booth at the other end. There were a few people in clusters and so I made a bee line for a drink, asked the bar staff about what I could eat if gluten and sugar free (they later produced a lovely plate of suitable food) and found someone to talk to. Started off with a chat with Steve McCabe MP Selly Oak, Birmingham (http://www.parliament.uk/biographies/commons/steve-mccabe/298) who told me about a relative with inflammatory arthritis who was finally helped by a specialised physiotherapist (?MACP). I managed to say a few words about the MACP and how fantastic we all were(!) and gave him a postcard for future reference. The place had filled up and there were probably around 45 people in the end. I saw Phil Gray, Chief Executive of the CSP from a distant but never got to say hello, he was in full flow with a group and seemed to already know quite a few people (as I guess you’d expect). I took the tip and interrupted a group introducing myself and again telling them (eventually) about the MACP; they each got a postcard -thank you Terry).  One person in the group was Dr Louise Warburton who is a GP and President of the Primary Care Rheumatology Society (https://www.pcrsociety.org/). I looked her up afterwards.

There were then a few short (thankfully) speeches. The MP, Linda Riordan (Chair for the All Party Parlimentary Group on Chronic Pain)  introduced and welcomed everyone. Stephen Wolstenholme then  talked about having arthritis and against advice had got back to running and was doing well.  Professor Peter Kay (no, not the comedian), National Clinical Director for MSK Conditions, NHS England talked sensibly about arthritis and the value of Arthritis Research UK. Finally Dr Liam O’Toole, Chief Executive, Arthritis Research UK gave a very good speech about the proposals being put forward. The charity is calling for changes to improve the health and wellbeing for people living with arthritis and musculoskeletal conditions. These include: 

·        Musculoskeletal conditions to be included in Public Health England’s strategic priorities; 

·        A call for NHS England to fulfil the NHS Mandate objective to offer everyone with a long term condition a personalised care plan 

·        NHS England and the Health and Social Care Information Centre to prioritise the systematic collection of data about musculoskeletal conditions within the NHS. Further information can be found at:http://www.arthritisresearchuk.org/news/press-releases/2013/october/arthritis-research-uk-welcomes-political-leaders-support-for-national-arthritis-week.aspx#sthash.cIWgjT3U.dpuf and http://www.arthritisresearchuk.org/

These proposals seemed very sensible and I got quite excited about what they were saying. I got to chat with Liam immediately after and told him about the MACP and of course gave him a postcard. He seemed more interested in having a further conversation about AHPRN and potential links the two organisations may have, but at least he got a postcard. 

I then began to feel tired, always find it exhausting being on my best behaviour with strangers, and particularly so when not really sure what to say to anyone, except have you heard of the MACP and please take one of these postcards. It was 2.40pm and decided to call it a day. On my way out, took the opportunity to have my photo taken holding a placard ‘I support Arthritis Research UK’ and wondering whether I’ll ever get sent it – nothing so far. Have a feeling it would be for the MPs who dropped in to ?have lunch. Dusted my feet off and headed for some retail therapy!


Matt Low, MACP secretary on his challenging introduction to extended scope roles

My First Day as a Spinal ESP

My name is Matthew Low and I am the Lead Clincian of Musculoskeletal Therapy Services and an Extended Scope Practitioner (ESP) in back pain in a consultant-led rheaumtology department. I have recenty been involved in the MACP executive comittee and hope to be voted in as secretary at this year’s AGM. I was asked to contribute to the blog to disuss a day in the life of a new executive comittee member. As I have only been to one exec meeting I thought I might instead write about my first and most memorable spinal ESP clinic.

Several years ago I was fortunate enough to be successfully selected to begin training as a spinal ESP. The process itself was excellent. I observed and led clinics under the direct supervision of a Consultant Rheumatologist for one clinic a week for four months. Each week I had to present topics on new areas of learning ranging from medication managment and blood tests to MRI scan interpretation and discuss my reflections with my mentoring consultant. I was then observed running a clinic independently which acted as a summative examination and I was “signed off” as competent.

I was quite nervous the day of my first clinic even though the consultant I was training under was a few doors away, seeing her own list of patients. It was made absolutely clear that if there were any problems just to knock on the door and when the time was right we could discuss them. As it turned out, my list comprised of all urgent cases.

With slightly clammy hands that were clasped onto my patient list, I called out the first one. It was a young gentleman who clearly was in pain. He hobbled toward me and shook my hand as we went into the clinic room. He had severe right-sided sciatica that he had been struggling to manage for three months. Over the last three weeks, he started to get some altered sensation in his saddle area and decreased bladder control. Clearly, this was a concern. During the physical examination he had a reduced ankle reflex, reduced power of ankle plantarflexion with a positive crossover sign and severely limited trunk movement. I was immediately suspicious of cauda equina syndrome and politely asked the patient to get as comfortable as possible as I needed to discuss his case with the consultant. So, off I trotted to knock on the consultant’s door thinking how unlucky this poor patient was to present to me on my first day. I waited about five minutes and when the consultant finished with her patient, I presented the case. The response was initially surpising – “Have you done a PR exam?” Although this is absolutely the appropriate examination, I had not covered it at all in my training and the doctor knew it! I said that I had not and the doctor hurriedly went into my clinic room and gained consent for the examination. I was then taught how to perform it (I won’t go into any detail) and was asked to contact the Orthopeadic registrar for the patient to have an urgent MRI scan. Once that was done after a stressful one hour from the begining of the consultation, I called out the next patient.

This patient presented in a wheelchair. Unfortunately, she had a number of red flags that needed to be investigated. She reported unremitting low back pain with no radiation that was of a gradual insidious onset. She had lost over a stone in 6 weeks and had taken to sleeping in her arm chair. The physical examiation was brief and confirmed her very limited movements and disabling nature of non-mechanical pain. Her neurology appeared normal. Once again, the corridors echoed with my footsteps as I headed to the consultant’s door to confirm the plan: blood tests and an urgent MRI scan of her lumbar spine. The consultant agreed and I had the challenging conversation with the patient that her back pain was unusual and we needed to exclude any nasty pathology. She was very grateful for the speedy investigations and how we were dealing with the situation.

By this stage, I had become a sweaty mess and I was very grateful that I had only three patients on my list. I walked into the waiting room and called out my last patient. To my relief, the gentleman looked up and his face was not riddled with pain. He called out “Yes, that’s me!” and proceeded to stand up. To my horror he picked up his walking stick and was stuck in flexion and had a huge list to his right. He waddled his way towards me and I invited him into the clinic room. He had a very kind nature and he explained how he enjoyed walking in the New Forest and that it was his main hobby. He reported that about ten weeks ago, he had been walking on familiar tracks and he developed right sided leg pain. It was accomponied by a rash and the pain appeared to be in the L4 dermatome. He denied any fever or weight loss and there were no other red flags. Upon physical examination, this poor chap was very unsteady on his feet, his back appeared warped with the most peculiar list to the right. All movements of his back were very painful and had no clear relationship to his leg pain. Examination of the hips were unremarkable. His neurological examination revealed profound weakness of his right quadricep, hamstring and gluteal muscle groups. His lower limb tone was normal and he had downgoing plantars and negative clonus tests. His knee reflex was absent and ankle reflex was normal. There was no evidence of a rash on his legs. I asked the patient if he had been bitten by anything and he denied it although he could not remember. Once again, the noise of my heels hitting the corridor floor on the way to the consultant’s office was audible as was the familar knock on the door. The consultant, as always, was fantastic and listened carefully to the story. She must have felt sorry for me as she reassured that because the clinic list was new it was filled by urgent patients. I recalled the patient’s presentation and immediately the consultant looked puzzled and agreed that we should scan the lumbar spine but also check for Lyme disease and filled out a blood test form. I returned to the patient and explained the situation and he appeared happy. That was my first experience of being a spinal ESP. Wow!

What came of these patients, I hear you ask!?

The first patient had his scan which showed a small central disc prolapse at L5/S1 without any neural compression! Strangly enough the patient also failed to attend any follow up appointments and I have no idea what came of him.

The second patient had bony metastasis in her lumbar and sacral spine and was followed up by the oncology team. Unfortunately, I never saw her again.

The third patient had a pristine MRI scan with absolutely nothing wrong with it. However, the blood tests showed that he did indeed have Lyme disease and was started on the appropriate medication and was already making progess.

I am in no way saying that this day was typical but it just goes to show in the immortal words of Greg Grieve… “Things are not always what they seem initially – be informed and awake”.

The start of the MACP journey. A new blog from Lee, beginning his MSc leading to membership

What on earth am I doing here…?


Hello Readers,

My name is Lee and I’m currently studying for me MSc in Neuromusculoskeletal Physiotherapy (MACP) at Cardiff University. I have kindly been asked to add some of my thoughts (candid or otherwise) to the MACP blog about my learning experiences.


Things you may like to know; I’m a mature student, ex-Army and have not long been a Physiotherapist. I graduated in 2010, completed my B5 rotations then after 16 months was a B6 at the same time working in private practice in SE London.

 I have since moved to Bristol, in the process of buying a house, moved twice in the space of 3 months, had a baby (not me obviously) and set up my own business. Now I’ve decide to go back to school, some may say brave, mental, silly and a glutton for punishment. Whatever the word/saying is I’m just looking forward to the journey, the learning process and to see what it takes to become one of over 1100 members in the MACP.

 I’m not sure if it has dawned on me yet what it takes to pass this course and become a member of the MACP. We had a lecture the other day and I was reading a piece on M-level learning and I know now that there is a big leap from undergraduate level. I had realised there was a difference but maybe not just how big it was. In fact it’s not so much the gulf it’s the fact that you’re kinda on your own. What I mean by that is you are in essence spoon fed to an extent at BSc but here you’re expected to be so much more, have your own opinions, formulate your own thinking, critically analyse and evaluate what you read and work out if it is worth reading some more. Then you are asked to work with minimum supervision, develop better oral and written skills and pay for the pleasure!

 This is all before you work out your Personal Develop Planning (PDP) this includes Identification of training needs and you do this with a skills assessment, you have to manage your expectations for the year, then you reflect and record your progress in a folder, online or any other way you can get it all down as a document for you to add and recall whenever you need.

 Just a quote from one of the documents that I read

            Learning to think critically is considered to be one of the most significant activities of adult life. Brookfield (1987) defines critical thinking as ‘calling into question the assumptions that underlie our customary ways of thinking and acting and then being ready to think and act differently on the basis of this critical questioning’.

 Hands up if you understood that? Hmm…not many! Why can’t they just write normally…I tried to look at this book but it was taken aback by the wash of information that comes up when you Google search the said author? Whatever model you choose to base your critical thinking process on whether it be Brookfield (1987), Norris and Ennis (1989) again a 5 phase model or ‘set of abilities’, Bullen (1998) four phases or Garrison, Anderson and Archer’s (2001) ‘Community of Enquiry’ (what?) it is plain to me that everyone has an opinion or a method that you can follow to really evaluate what it is your thinking and questioning.

 There is going to be a point in the very near future that this whole process will be defined. I know that it will click, the penny will drop and I’ll ‘just get it’. It hasn’t happened yet and it’s not supposed to. I asked a tutor the other day “is it normal to feel like I haven’t a clue what’s going on?” reply “yes” and I said “I’m glad about that, as I thought it was just me!”

 I mean at the minute I’m thinking about my research topic, nothing coming out and biting me on the backside as yet. Something on the shoulder perhaps, comparing two devices for measuring ROM or improving scapula muscle function through improved thoracic mobility (got to be on normal’s though)…oh I don’t know. Suggestions on a post card please!

 So “Why am I here?” well if I could give you a straight answer to that then I’d be a much better critically thinker than I am right now, then I would give you a different answer based on this critical questioning.

 What I do know is that an MSc is hard; if it wasn’t then everybody would do it. They are expensive and like black holes consume everything (nearly), they test your patience and sanity. So on day one I wrote on the top of my pad “what is the goal?” well I want to be the best clinician I can be not just for me but for my patients. I want to work alongside good, experienced clinicians and learn as much as I can. Develop myself and contribute to the profession at large, be a clinical specialist.

 When I achieve that then I’ll know exactly why I’m here…

 Remember, every day is a school day.


A fantastic blog from the MACP PDC officer on the challenges of developing MACP CPD courses. Will he sink or swim??

Simon Smith, Lower Quadrant MSK Extended Scope Practitione. Co-Chair, Professional Development Committee (PDC), MACP.


Having read Jenny’s great blog post from a few weeks ago I felt inspired to write one of my own. So here goes!

Like most people I come across these days that work in the NHS, my job as an Extended Scope Practitioner with an MCATT service is incredibly busy. My work with the PDC is supported by my employer, but realistically most of the work is done in the evenings and at weekends. In my mind the tasks I have on the PDC appear to be split between three different domains, managing the 9 strong committee, arranging and developing existing courses and looking to try to develop new ideas and development opportunities for our members with my Co-Chair Helen Welch. Most of this is done by email and on the telephone. A typical week sees 50+ emails go through my account.

Although it was a busy one, it is weeks like this that remind me why I chose to take on the role I have with the MACP. It was excellent.

Monday 23rd September.

Monday is always a wrench, I’ll not lie. I have two young kids and my eldest has just started school, so weekends are great family times. I’m brought back to the real world by my 8am patient. My evening clinic on a Monday finishes at 7:30pm so I always feel like I’ve earned a rest after the day. Today was different however. I had an exciting evening meeting booked over a burger and a pint. I shall explain my disproportionate excitement about an after work burger!

When I look back at the people who have influenced my career, I site my engagement with the MACP firmly at the door of a chap called Gary Rogerson. I worked with him as a junior while in Leeds. His ability to clinically reason through a patient was always impressive, but above all his ability to communicate his thought processes and further the practice of those around him was striking. He was and still is an MACP member and the person that introduced me to really structuring my thoughts and sparked a real interest in MSK. Although he does support the wrong football team, as a young impressionable physio I thought it was a good thing to be like Gary!!.

As a member of the PDC I feel that we should be providing opportunities for learning in extended roles as we do currently, but I feel very passionate about the fact that we should also be providing opportunity to spark interest in people at the beginning of their career. At our last executive committee meeting I received some clarity on how the MACP wished to proceed with bringing back courses aimed at advancing clinical reasoning skills for AfC band 5 and 6 physiotherapists. It was with great glee therefore that I arranged a meet with a friend and colleague James Midgley about the development of a clinical reasoning course for the knee. Both James and I spend our working days assessing knees, but also take great enjoyment in clinical discussion and mentorship with our wider physiotherapy team. Although the thought of burger and a pint was appealing, it was the act of getting moving on a task we have been talking about for months that really excited me.

I left the Dormouse pub in Clifton with a spring in my step, a burger in my belly and a really quite exciting outline for a one day clinical reasoning course in my hand. Watch this space!

Tuesday 24th September 2013

The pay off for working two evenings a week is that I get to have a Tuesday off work and look after my children. I delivered my boy to school and my daughter Isla and I returned home to read books and put nappies on dollies. Anyone with a two year old will know that this can literally go on and on and on and on…!

Tuesday is also a time where I try to get a lot of email contact sorted. On my radar at present is the running of the Introduction to MSK radiology course and the organisation of our Cervical Artery Dysfunction course. The ladies that have developed the CAD course for the MACP have put a terrific amount of work into it and the PDC is trying to arrange some dates for this to run.

Generally speaking by the end of a Tuesday, although I love my children dearly and I really quite enjoy the MACP work, I am glad to go out for a ride with my cycling club chaingang. My wife comes home from work to take over the mayhem. This Tuesday was no different

Wednesday 25th September 2013

I learnt a few months ago that I was not quite the athlete I thought I was. I enrolled on the Leeds Xpress Triathlon, trained diligently on the bike and even went for a few runs. However I found out that throughout my adult years what I thought was swimming is actually flapping about in the water while holding my breath. This is fine for short distances, but for completing a triathlon it is a tad embarrassing. After taking 24 minutes to swim 16 lengths I vowed to come back stronger, but with the ability to swim. Wednesdays now see me working through the day, home to bath the kids while my wife runs, then out to adult beginners swimming lessons. I’m not proud!

Friday 27th September 2013

All week I had been fielding emails about the first running of the MACP’s Spinal Masqueraders: Expanded course, due to take place on Saturday. We developed the Spinal Masqueraders Study Day, the prequel to this new course with Chris Mercer, Laura Finucane, Sue Greenhalgh and James Self back in 2009. This has been incredibly well received. The remit of this course was always to give an advanced practice view on the recognition and management of serious pathology masquerading as spinal and radiating pain. When we developed this we figured that Cauda Equina Syndrome and Abdominal Aortic Aneurism are commonly discussed and that our study day should focus on some of the less commonly seen masqueraders. However the feedback we have received over the 2 years this course has been running is “why do you not cover CES or AAA”. The market clearly existed for a course covering these topics so a year ago Chris, Sue, Laura and myself arranged a teleconference and bashed out some ideas. What came out of this was Spinal Masqueraders: Expanded. You can imagine that after a year’s preparation I was quite anxious that all would go well.

When we run a course under the PDC commonly what happens is that we look to recruit someone locally to organise the day, book rooms, order refreshments and put up signage. As this course was to run at York, my home city, I took this role on. Not only did I have the anxiety surrounding our new course, I also had to make the right choice of biscuits for our delegates. I took to Twitter for help with this issue. Twitter did not disappoint. I was clear that if I bought Jammy Dodgers and Chocolate Hobnobs all would be well. Thank you @kedarkale16 and @littlephysio, it would have all been a disaster if it wasn’t for you. Friday, after my clinical work I bought biscuits and put up signs.

I went home expecting to go back to York to have a beer with Chris and Laura when they got to their hotel. At 9:30pm when they were still stuck in traffic in Luton I shelved any plans for beer and started to worry that I might not have lecturers for Saturday

Saturday 28th September 2013    


The big day! I got to York Hospital early to make sure all was well. I texted Chris, he was in Yorkshire. All seemed well. 30 delegates arrived, nobody complained about the biscuits and everyone seemed happy.

After my short introduction to the course Laura Finucane kicked the day off with a presentation entitled ‘Not all leg pain is from the back’. Laura’s remit was to discuss pelvic masqueraders. I know from previous experience that when Laura presents you will get a very well researched complete appraisal of a topic, delivered in a way that is easy to digest and engaging. She did not disappoint. Following on from this Sue delivered a further presentation under the heading Cauda Equina Syndrome; Before or After the horse has bolted. Sue has been involved in recent research in this area and is able to talk on the subject with levels of assurance matched by very few others. She truly is an expert in her field and her presentation reflected this.

Although the day started with a few presentations, this is really aimed at getting everyone warmed up and thinking. The main thrust of the day was to enhance delegate’s clinical reasoning of cases of masquerading spinal pain. Hence the majority of the day was given over to case presentations and clinical reasoning workshops. There has been a slight change of emphasis from the Spinal Masqueraders Study day to Spinal Masuqeraders: Expanded, we aimed to engage delegates to a greater degree in the reasoning of cases. This sounds wonderful, but in practice if the people that attend on the course don’t engage, the day will not be as great an experience. Essentially if you’re a delegate, you get out what you put in. I worried before the day that this might be a stumbling block. I needn’t have done. The course was filled with bright inquisitive clinical reasoners; A real credit to our profession. From our first case study session onward I knew the day would be a success. Thank you to the York 30!

After lunch, just as our stomachs may have been telling us that we had gorged too much at Costa, Chris kindly kicked the afternoon off with a presentation on visceral pain. I’m not sure if this is a selling point or not, but Chris (unbeknown to me) had planned to get his abs out to make a point or two. I’d not book onto a course specifically to see this, but some might. I couldn’t bring myself to take pictures for Twitter. You’ll have to book onto the course yourself if you wish for more information on this subject. Chris works as a Consultant Physiotherapist down on the South Coast. His breadth of knowledge is frankly scary. If ever there was a man that never rests on his laurels, never thinks he knows all he needs, it is Chris. His scope of practice seems potentially endless. A true trailblazer in physio I feel. Abs aside, his presentation was great, everything I would expect from him really.

The day finished off with further case clinical reasoning and some time to discuss any issues arising from the day in our panel discussion. The biggest selling point for this course is, I feel, the easy access you have to some great clinicians whom in their roles as Consultant Physiotherapists can give advice on forging new and developing existing extended role pathways. I’m biased, but if you’ve not been on one of our Masqueraders courses you really must.

Above all I finished my day on Saturday pleased all had gone well. Pleased that I’d enjoyed a day of discussion and learning and pleased that I was part of the vibrant intelligent profession that is physiotherapy.


A magical week

Jenny Ward, Spinal ESP, MACP communications officer, MSK AHPRN hub facilitator for Surrey and Sussex

Well I thought I would kick off my first blog post with what was a roller coaster of a week at work….

Monday 16th September

The week begins with some last minute preparations for the MACP committee meeting on Tuesday.  Id love to say that Im always organised and get everything prepared weeks in advance but alas, those who know me would know this is not true.  Monday evening dawns and I am busily re checking my action points from the last meeting in July, re reading the minutes, reviewing the reports submitted by each of our executive committee members (we all have to submit a report several weeks before each committee meeting so the busy, face to face meetings can run as smoothly as possible) and finally whipping up an advert to go out to new students about the ever expanding MACP twitter feed and Facebook page.  Its a busy but productive evening and I go to bed feeling prepared for the day ahead.

Tuesday 17th September

Its an early start today, heading up to London by train and jumping on the tube to Camden.  My destination… Elsevier publishing house for the MACP committee meeting.  On the tube journey I find myself reflecting on the many hours I spent commuting as a junior physio, whilst working in London and how at that point in time,  I could never have foreseen where my career would take me…

The London meetings are  held every 3 months and are a great opportunity to push our strategy forwards and network with the other committee members.  The journey is smooth and I arrive in good time to have a catch up with everyone before we start.  The committee members present today included;

  • Chair; Clair Hebron,  course leader for the NMSK course at Brighton university
  • Research officer; Dr. Neil Langridge, consultant in the New Forest
  • Professional Network and Diversity officer; Dr Chris McCarthy, Imperial college
  • Simon Smith; clinical specialist in York
  • Jay Cookson, MSK clinical specialist
  • Secretary and all round backbone of the committee…. Terry Smith


The extra face is Matt Lowe, Team lead and ESP who is shadowing the secretary role and is a welcome addition to the team.

The meeting runs with smooth precision, to allow us time to get through the many action points and agendas.  Matter arising from the last meeting are reviewed and then individual reports are discussed.  I present my report on the communications strategy for the MACP, which highlights the huge success of our recently launched twitter feed, now with over 1000 members.  The twitter feed, and new Facebook page are fantastic resources for to the minute research and clinical debates, links to journal articles and podcast and not to mention unlimited networking opportunities with MSK therapists.  Check it out @PhysioMACP or through Facebook on MACP Physiotherapy.

Much of the focus for todays meeting was in preparing for our upcoming AGM on 10th of October.  As a committee we have to plan down to the last detail, aspects such as what MACP promotional goods to order, who will register names for the AGM, who will take the pictures of the new members receiving their awards and so on.

Before joining the committee I had failed to appreciate  how much planning and precision is involved in making a large meeting (such as an AGM) run ‘effortlessly’.  Consider then, the planning, marketing, advertising, organising and implementing involved for the MACP in 2016 at the Glasgow IFOMPT  conference…..  Work has started already from a hugely dedicated, yet entirely voluntary IFOMPT committee which was established once the MACP bid to run the conference was successful last year….  Check out http://www.ifomptconference.org/ for more information.

Wednesday 18th September

A well earned break today to celebrate my husbands birthday.  We head up to Warner Brother studios to check out the Harry Potter exhibition.  A fascinating insight into the world of CGI, Special Effects, Costume design, makeup and the inspiration provided by artist and graphic designers in the final imagery of the film.  And yes ok, Im ‘out of the closet’ as  a Harry Potter fan….

Thursday 19th September

Im excited about today.  As AHPRN facilitator I organise twice yearly research seminars for the Surrey and Sussex area, and with the meeting today, Dr. Annina Schmid is speaking about her journey into research as well as some of her recent research findings.

Despite the wind, rain and eventual thick fog which blights my journey to the Eastbourne campus, our research sessions goes very well.

Annina is a fantastic speaker, and a real inspiration.  The first half of the session, we learn about how Annina developed from an undergraduate  ‘in love with physio’ but disillusioned that patients did not fit the text book descriptions , to applying for her MSc in Austraila and becoming hooked on research. Her path into a Phd was a rocky road with some knock backs along the way, but she persevered and succeeded despite these knock backs to become a self proclaimed ‘nerve nerd’, and is not working on her second postdoctoral fellowship at Oxford university.  It was a motivational story of where a ‘go get it’ attitude  can take you.

The second half of the session was a fascinating insight into some of the most recent nerve entrapment research.  Much of her research is focused around the role of immune mediated inflammatory changes within nerves exposed to mild gradual constriction.  They have found evidence of inflammatory mediators within the nerve, both locally at the site of the constrictions and also at the dorsal root ganglion which provides an interesting theory of the role of immune inflammation on patients with ‘double crush syndrome’.  There was also evidence of demyelination of the nerve at the site of constriction and the research postulates that the myelin might act as a foreign body instigating a ‘auto immune’ type response.  Check out Anninas publications at http://www.neuro-research.ch/

Friday 20th September

My final trip to London for this week.  Its another early start to get to Kings college in time to provide the new students studying a route to MACP entry with a lunch courtesy of the MACP and presenting to them, the role of the MACP in MSK physiotherapy and how the MACP can help them through their journey as a student, including access for associate members to bursaries, the manual therapy journal, full text articles from the  Elsevier website, clinical mentors database and forum and clinical support from the MACP secretary.

IMG_1586 IMG_1584

Its been a busy and productive week.  I hope you have enjoyed reading this blog and gained a better insight into the activity of the MACP.