GUEST EDITORIAL ■ by Moira van Oordt BROADLY SPEAKING A m o n g s t th e c u r r e n t " b u z z " w o r d s b e i n g b a n d i e d a b o u t a r e " V i s i o n " , " V a l u e s " , " C r e d i b i l i t y " a n d " R D P " . T h is e d i t i o n o f th e jo u r n a l h a s b e e n a llo c a t e d t o m a tte r s m a in ly p e r t a in in g to o r t h o p a e d ic m a n ip u la t iv e th e r a p y ( O M T ) a n d a s s u c h , th e id e a s m e n t io n e d in th is e d ito r ia l w ill r e f e r t o O M T . H o w e v e r , th e p r in c ip le s s u g g e s te d c a n b e t r a n s la te d t o m e e t th e n e e d s o f w h o le g a m u t o f s p e c ia l in te r e s ts in p h y s i o t h e r a p y in o u r c o u n tr y . A " V i s i o n " is d e s c r i b e d a s " s o m e t h i n g w e h a v e y e t to d o " .. I t is m e a s u r e d b y th e v a lu e s w e s e t f o r o u r s e lv e s . I f w e a r e to s u r v iv e a s p h y s i o t h e r a p i s t s w h o h a v e a s p e c ia l i n te r e s t in O M T w e h a v e t o d e c id e w h a t o u r p r o b le m s a r e , w h a t w e a r e g o in g t o d o a b o u t th e m a n d h o w w e a r e g o in g t o m e a s u r e th e o u tc o m e . W e s h o u ld b e m o tiv a te d to p la y o u r p a r t, e s p e c i a ll y s in c e a s tu d y in T im e m a g a z in e , J a n u ­ a r y 4 , 1 9 9 3 i n d ic a te d t h a t p h y s io t h e r a p is t s w e r e a m o n g th e p e o p le w h o w o u l d b e m o s t in d e m a n d in th e n e x t d e c a d e . F u r th e r , w e s h o u ld a ls o ta k e n o t e o f th e a d v ic e g iv e n b y i m m e d i a t e p a s t P r e s i d e n t o f W C P T , P r o f e s s o r A J F e r n a n d e z . In a n a d d r e s s d e liv e r e d a t th e 5 th I n t e r n a ­ t io n a l C o n g r e s s o f th e I n t e r n a t i o n a l F e d e r a tio n o f O r t h o ­ p a e d ic M a n i p u la t i v e T h e r a p i s t s in V a il, C o lo r a d o 1 9 9 2 , h e s a id t h a t w e s h o u ld d o e v e r y t h i n g in o u r p o w e r to b r in g th e T h ir d W o r ld u p t o o u r s ta n d a r d s a n d n o t d r o p o u r s ta n d a r d s t o m e e t th e T h i r d W o r ld . W e w ill h a v e to c a s t o u r n e ts w id e ly t o e n v e lo p a ll th e s e fa c to r s in th e c h a lle n g e th a t fa c e s u s. It is m y o p in i o n t h a t o u r m a in p r o b l e m r e m a in s th e p u r s u it o f e x c e lle n c e in th e s e r v ic e s w e p r o v id e . T im e s d o h o w e v e r c h a n g e , a n d e m p h a s i s in o u r p u r s u it h a s to b e c o n s ta n tly r e - e v a lu a t e d . B e s i d e s u p h o ld in g c lin ic a l e x c e l ­ le n c e w e h a v e a n u r g e n t n e e d to b e c o m e i n v o lv e d a s h e a lt h p r o m o t e r s . R u t h G r a n t , a d d r e s s i n g th e C e n t e n a r y C o n ­ g r e s s o f th e C h a r t e r e d S o c i e t y o f P h y s io t h e r a p y in 1 9 9 4 , s a id t h a t th e r e is in c r e a s i n g s u p p o r t f o r e n c o u r a g in g a h e a lt h y l ife s ty le a n d s t r e s s e d t h a t p h y s io t h e r a p y s h o u ld m a in t a in a s t r o n g r e le v a n c e to th e n e e d s o f th e c o m m u n ity . O n e a r e a s h e ta r g e t e d w a s p h y s i o t h e r a p y p r e v e n t i o n a n d i n t e r v e n t i o n p r o g r a m m e s in in d u s tr y . P h y s io t h e r a p is ts w ith O M T a s a s p e c ia l in t e r e s t c o u ld m a k e a n im m e n s e c o n t r ib u t io n in th is s p h e r e . O n e o f th e a s p e c ts w h e r e o u r p r e v e n tio n s k ills a r e n o t fu lly r e a lis e d is th e m a n a g e m e n t o f n e c k a n d s h o u ld e r p a in . M e d ic a l lit e r a t u r e f r e q u e n tly r e fe r s to th e fa c t th a t a t s o m e tim e d u r in g t h e ir l if e s p a n 8 0 % o f p e o p le w ill h a v e s o m e f o r m o f m e c h a n i c a l b a c k p a in . T h e a e tio lo g y is u s u ­ a lly a s c r ib e d to th e s tr u c t u r a l w e a k n e s s in c u r r e d b y h u ­ m a n s in a tta in in g th e u p r ig h t p o s t u r e . L it e r a t u r e a l s o r e ­ fe rs to th e lo s s o f w o r k d a y s i n c u r r e d in i n d u s t r y d u e to b a c k p a in . A s m e c h a n i s a t io n c r e e p s f u r t h e r a n d fu r th e r i n to o u r c u r r e n t life s ty le s , it s e e m s t o m e a s i f th e s e d e n ta r y p o s itio n s a n d n e c k p o s t u r e s i m p o s e d o n u s w h e n w e u s e c o m p u te r s a n d v ie w t e le v i s io n s c r e e n s is n o t o n ly i n c r e a s ­ in g th e in c id e n c e o f b a c k p a in b u t a l s o in c r e a s i n g th e in c id e n c e o f n e c k a n d s h o u ld e r p a in . In fa c t th e in c id e n c e o f n e c k a n d s h o u ld e r p a in s e e m s a ls o t o b e fa s t a p p r o a c h i n g a n i n c id e n c e o f 8 0 % a m o n g s t p e o p le e n g a g e d in th e s e s o r t s o f a c t i v i t ie s w h e t h e r in th e lin e o f d u ty o r in p u r s u i t o f le is u r e . In a d d i t i o n s tr e s s le v e ls a r e a n a c k n o w le d g e d f a c t o r in o u r liv e s t o d a y a n d Ja n d a d r a w s o u r a t t e n t io n t o th e c lo s e a s s o c i a t io n o f th e lim b ic s y s t e m w h ic h p r o c e s s e s th e s e s t r e s s e s to th e s h o u ld e r - n e c k c o m p le x . O n e a s k s th e q u e s t io n , " h o w m a n y m a n h o u r s a r e c u r r e n tly b e i n g u n d e r - u t ilis e d a n d / o r lo s t d u e t o n e c k p a i n ? " T h e e s s e n c e o f q u ic k ly r e s t o r i n g o u r c lie n ts t o o p t im a l f u n c tio n in th e w o r k i n g e n v i r o n m e n t in v o lv e s m a n u a l t h e r a p y t e c h n iq u e s , c l in i c a l r e a s o n in g , d if f e r e n t ia t i o n o f b o d y s t r u c t u r e s , s p e c if i c a l ly d ir e c t e d c o u n s e l l in g , a n d t r e a tm e n t. We sh o u ld also ap p ly th ese sk ills to ex p lo rin g the p rev en tion o f this sy n d rom e. T o d a y m o r e th a n e v e r it is e s s e n tia l to k e e p o u r w o r k i n g p o p u l a t io n p r o d u c t i v e b e ­ c a u s e it is o n ly t h r o u g h th e m t h a t o u r e c o n o m y c a n b e s u p p o r te d a n d w ill s u r v iv e . M a n u a l th e r a p is ts m u s t c o n t in u e t o s t r iv e f o r e x c e l ­ le n c e in s e r v ic e a n d m u s t e n d e a v o u r to u p h o ld t h e ir s t a n d ­ a r d s o f p r a c t ic e . U n d e r - g r a d u a t e , p o s t - g r a d u a t e a n d c o n ­ tin u i n g e d u c a tio n p r o g r a m m e s m u s t b e e q u a ll y e x c e lle n t. C lin ic ia n s , a s p a r t o f th e c o m m u n i t y , s h o u ld b e h e lp in g to id e n tify c u r r e n t n e e d s a n d g u i d in g r e s e a r c h e r s to fin d a n s w e r s . M a n u a l t h e r a p is t s s h o u ld r e d e f in e t h e ir " V i s i o n s " a n d m e a s u r e th e m a g a in s t th e v a l u e s t h e y s e t f o r t h e m s e lv e s . P e r h a p s , o n c e a g a in , th e w is e b u t s im p le w o r d s o f P r o f e s ­ s o r A J F e r n a n d e z a t th e 1 2 th I n t e r n a t i o n a l C o n g r e s s o f th e W o r ld C o n f e d e r a t io n o f P h y s ic a l T h e r a p y , 1 9 9 5 (H a n s ­ fo r d , 1 9 9 5 ), c o u ld g u id e u s a n d w e c o u ld u s e h i s id e a s o n c r e d ib ilit y a s a m e a s u r e m e n t . " H a v e w e d o n e s o m e th in g g o o d , h a v e w e s e r v e d , h a v e w e c a r e d a n d h a v e o u r c lie n ts b e n e f i t t e d ? " F o r th e s e , a f te r a ll a r e s u r e l y o u r " V a l u e s " . R e fe re n ce s 1. Barker J. T he P ow er o f Vision. V id eo tap e, V ision s Inc. U SA . 2. Jand a V. P hysical Therapy o f th e C ervical an d T horacic Spine. C hurchill Livin gstone, N ew Y ork 2nd E d. 1994:195-216. 3. G ran t R. T he P u rsu it o f Excellence in the F ace o f C o n stan t C hange. Jnl Phys. 1995;81(6):338-344. 4. H ansford P. Letter to E d ito r, SA Jnl. P hys. 1995:51(4):69. B la d s y 2 F e b r u a r ie 1996 SA T y d s k rif F is io te r a p ie , D e e ! 5 2 N o 1 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )